CT Patterns of Interstitial Lung Disease in Patients with Plaque Psoriasis: A Retrospective Case Series Study.

Background and Objectives: Recently published articles reported an association between psoriasis and interstitial lung diseases (ILDs). The aim of this study is to evaluate the differences in ILD computed tomography (CT) patterns between smoker and never smoker plaque psoriasis (PP) patients under topical treatment without psoriatic arthritis (PA), inflammatory bowel disease (IBD) or connective tissue diseases (CTDs). Matherials and Methods: Two radiologists evaluated chest CT examinations of 65 patients (33 smokers, 32 never smokers) with PP. Results: Usual interstitial pneumonia (UIP) pattern was diagnosed in 36 patients, nonspecific interstitial pneumonia pattern in 19, hypersensitivity pneumonitis in 7 and pleuropulmonary fibroelastosis (PPFE) in 3 patients. UIP pattern showed a statistically significant higher frequency in smoker patients (p = 0.0351). Respiratory symptoms were reported in 80% of patients. Conclusions: ILDs seems to represent a new comorbidity associated with psoriasis. Moreover, a statistically significant association between smokers and UIP pattern in PP patients is found. Respiratory symptoms should be evaluated in PP patients, in collaboration with a radiologist and a pneumologist. However, further studies are required to better understand the epidemiology of ILDs in PP patients.

Ultra-low-dose chest CT in adult patients with cystic fibrosis using a third-generation dual-source CT scanner.

INTRODUCTION: Chest computed tomography (CT) examinations are performed routinely in some cystic fibrosis (CF) centers in order to evaluate lung disease progression in CF patients. Continuous CT technological advancement in theory could allows a lower radiation exposure of CF patients during chest CT examinations without an image quality reduction, and this could become increasingly important over time in order to reduce the cumulative radiation dose effects given the continuous increase of CF patients predicted median survival. OBJECTIVE: The aim of this study was to compare objective and subjective image quality and radiation dose between low-dose chest CT examinations performed in adult CF patients using a third-generation DSCT scanner and a 64-slices single-source CT (SSCT) scanner. MATERIALS AND METHODS: Between January 2016 and August 2019, 81 CF patients underwent low-dose chest CT examinations using both a 64-slices SSCT scanner (2016-2017) and a third-generation DSCT scanner (2018-2019). Objective image noise standard deviation (INSD), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall subjective image quality (OSIQ), subjective image noise (SIN), subjective evaluation of streaking artifacts (SA), movement artifacts (MA) and edge resolution (ER), dose-length product (DLP), volume computed tomography dose index (CTDIvol) and effective radiation dose (ERD) were compared between DSCT and SSCT examinations. DSCT examinations consisted in spiral inspiratory end expiratory acquisitions. SSCT examinations consisted in spiral inspiratory acquisitions and five axial expiratory ones. RESULTS: DSCT protocol showed statistically significant lower spiral inspiratory phase mean DLP, CTDIvol and ERD than SSCT protocol, with a 25% DLP, CTDIvol and ERD reduction. DSCT protocol showed statistically significant higher overall (inspiratory and expiratory phases) mean DLP, CTDIvol and ERD than SSCT protocol, with a 40% DLP, CTDIvol and ERD increase. Objective image quality (INSD, SNR and CNR) and SIN differences were not statistically significant, but subjective evaluation of DSCT images showed statistically significant better OSIQ and ER, as well as statistically significant lower SA and MA with respect to SSCT images. CONCLUSIONS: To our knowledge, this is the first study evaluating chest CT image quality and radiation dose in adult CF patients using a third-generation DSCT scanner, and it showed that technological advancements could be used in order to reduce radiation exposure of volumetric examinations. The spiral inspiratory dose reduction can be obtained with concomitant improvements in subjective image quality with comparable objective quality. This will probably allow a wider use of this imaging modality in order to assess bronchiectasis and will probably foster spiral expiratory acquisition for small airways disease evaluation.

Shear wave elastography and transient elastography in HCV patients after direct-acting antivirals.

PURPOSE: To compare the ultrasound (US) and pulse shear wave elastography (pSWE, Elast PQ®) methods with transient elastography (TE), clinical scores and laboratory tests, during the follow-up of HCV patients receiving direct-acting antiviral drugs (DAA). METHODS: Our prospective study from June 2016 to December 2017 included 22 consecutively enrolled HCV-positive patients (59.7 ± 12.3 years, 11 male) which were subjected to antiviral therapy. All patients underwent B-mode ultrasound, color-Doppler, pSWE and TE five times: before therapy (T0), at the end of therapy (post-Tx), and at 12, 24, 48 weeks post-therapy. The liver stiffness (LS) values obtained with pSWE and TE and the data coming from US assessment and clinical evaluation were compared. RESULTS: We obtained a statistically significant reduction of LS values (kPa) measured by pSWE, between T0 (14.3 ± 9.3), post-Tx (11.8 ± 10.5), 12 weeks (7.5 ± 3.3), 24 weeks (8 ± 3.8) and 48 weeks (8.5 ± 4.6) (p = 0.02). The reduction of kPa measured by TE was not significant between T0 (14.7 ± 9.3), post-Tx (12 ± 9.5), 12 weeks (11.6 ± 7.7), 24 weeks (10.3 ± 6) and 48 weeks (10.8 ± 7.5) (p > 0.05). Multivariate baseline analysis showed significant independent association among measurement of TE stiffness with cirrhosis, type of vein hepatic flow and showed significant independent association between delta-pSWE measurement (difference between stiffness measurements at the baseline and 12 months after treatment) with staging of fibrosis (p = 0.006) and sustained virologic response after 12 weeks of treatment (SVR12, p = 0.017). CONCLUSION: The pSWE method has shown better ability than TE to identify a reduction in LS. Therefore, pSWE allow to evaluate stiffness reduction in HCV patient during DAA treatment follow-up, which is related to SVR12.

Apparent diffusion coefficient values in borderline breast lesions upgraded and not upgraded at definitive histopathological examination after surgical excision.

PURPOSE: The study aims were to evaluate if the apparent diffusion coefficient (ADC) value could distinguish between breast lesions classified as B3 at core needle biopsy (CNB) that show or do not show atypia or malignancy at definitive histopathological examination (DHE) after surgical excision. MATERIAL AND METHODS: From January 2013 to December 2017, 141 patients with a B3 breast lesion underwent magnetic resonance imaging and were included in the study. The ADC value was assessed drawing a ROI outlining the entire lesion, evaluating the mean (ADCmean) and minimum ADC values (ADCmin). RESULTS: Both ADCmean and ADCmin values showed a statistically significant difference between B3 lesions without and with malignancy or, for B3a lesions, atypia at DHE. They both showed a statistically significant difference also between B3a lesions without or with atypia or malignancy at DHE, but only ADCmin (not ADCmean) showed statistically significant difference between B3b lesions without or with malignancy at DHE. CONCLUSIONS: The ADC value could help distinguish between B3a lesions without or with atypia/malignancy at DHE after surgical excision and between B3b lesions without or with malignancy at DHE. Therefore, it could be used to help guide the diagnostic-therapeutic pathway of these lesions, particularly of B3a lesions.

Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size.

PURPOSE: The aim of this study was to evaluate mammographic findings associated with invasive lobular carcinoma in different age groups, taking into account breast composition and tumour size. MATERIAL AND METHODS: A total of 1023 invasive lobular carcinoma preoperative mammograms were evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion, and asymmetry, and breasts were assessed as dense (C or D breast composition) or non-dense (A or B). The patient cohort was subdivided into 3 age groups (< 50, 50-69, ≥ 70 years of age). In order to make the size and age groups dichotomous variables and to perform multiple regression analysis, a cut-off of 10 mm was chosen for tumour size, and < 50-years-old and 50-69-years-old age groups were grouped together (< 70-years-old age group). RESULTS: Significant results of multivariate analysis were the association between mass finding and non-dense breasts and size ≥ 10 mm (p < 0.0001), between calcifications, and dense breasts, size < 10 mm and < 70-years-old age group (p < 0.0001), between distortion and < 70-years-old age group (p = 0.0366), and between asymmetry and ≥ 70-years-old age group (p = 0.0090). CONCLUSIONS: Various mammographic findings are differently associated with age group, breast composition, and tumour size.

Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study.

OBJECTIVES: To estimate the incidence of contrast-induced acute kidney injury (CI-AKI) after intravenous (iv) iodinated contrast material (ICM) exposure. METHODS: This prospective cohort study included all consecutive patients who underwent radiological investigations using low-osmolar iopamidol 370 mg/ml in a regional hospital over a period of 36 months, without any exclusion criteria. The estimated glomerular filtration rate (eGFR) was evaluated using the MRDR equation before (2-10 days) and after (24-36 h) radiological investigations. CI-AKI was defined as a ≥ 25% decrease in eGFR from baseline. CI-AKI incidence was estimated using a binomial distribution. The association between CI-AKI and demographic and clinical characteristics was modeled using logistic regression. RESULTS: The study included 1541 patients with a median age of 68 (1st-3rd quartiles 58-76) years with various comorbidities, 30% of whom had pre-existing CKD. Patients affected by stage III or IV chronic kidney disease (CKD) received an infusion of 0.9% normal saline (1.0-1.5 ml/kg/h) before and after iso-osmolar iodixanol administration. CI-AKI was observed in 33 patients (2.1%, 95% CI 1.5-3.0). The logistic regression analysis showed that antibiotic and statin therapies were significantly associated with CI-AKI. The probability of developing CI-AKI decreased by 80% in patients taking statins (OR = 0.20, 95% CI 0.03; 0.68) and increased approximately three times in patients with antibiotic therapy compared with those who did not take statins and antibiotics (OR = 2.92, 95% CI 1.21; 6.36). CONCLUSIONS: Our data suggest that low-osmolar iopamidol carries a low incidence of nephrotoxicity, even in subjects with various comorbid conditions or reduced renal function. KEY POINTS: • IV administration of ICM carries a low incidence of nephrotoxicity, which was transient in observed patients. • Statin therapy is negatively associated with AKI in patients exposed to ICM. • Pre-existing impairment of renal function is not associated with AKI in patients exposed to ICM.

Contrast-enhanced ultrasound in delayed splenic vascular injury and active extravasation diagnosis.

INTRODUCTION: We describe the use of contrast-enhanced ultrasound (CEUS) in the diagnosis of delayed splenic vascular injury (DSVI) and active extravasation (DAE) during spleen injury follow-up. CEUS might be used instead of contrast-enhanced computed tomography (CECT) during spleen injury follow-up in order to reduce radiation exposure. OBJECTIVE: Assess diagnostic comparability between CEUS and CECT in the evaluation of DSVI and DAE during spleen injury follow-up. SUBJECTS AND METHODS: A total of 139 trauma patients (101 males, 38 females; mean age 48.6 years) with CECT diagnosed spleen injury were prospectively evaluated. They performed CEUS and CECT follow-up. All CEUS studies were performed using the same ultrasound scan, convex probe, mechanical index and ultrasound contrast agent dose. Twelve patients performed digital subtraction angiography (DSA) during follow-up, and the diagnostic performance comparability between CEUS and DSA was evaluated. RESULTS: CEUS showed 17 delayed spleen injury complications, and in 122 patients no complication was suspected. CECT diagnosed 16 delayed spleen injury complications in these 17 patients and showed a small DSVI in another patient. A total of 122 follow-up CT scans were negative. CEUS and CECT diagnostic comparability was 98.6%. Compared to DSA, CEUS showed a sensitivity of 100% and a positive predictive value of 91.7%. CONCLUSIONS: CEUS can be used during spleen injury follow-up instead of CECT. Positive CEUS examinations could perform CECT and, when necessary, DSA in order to confirm and treat spleen injury complications.

Correlation between apparent diffusion coefficient of magnetic resonance imaging and tumor-infiltrating lymphocytes in breast cancer.

PURPOSE: To evaluate a possible correlation between apparent diffusion coefficient (ADC) value and tumor-infiltrating lymphocytes (TILs) level in breast cancer (BC). A second objective was to assess whether there were other histopathologic features that could affect mean ADC value. METHODS: In this 4-year retrospective study were included 125 patients who underwent radical or modified mastectomy for monofocal BC. All subjects had performed preoperative MRI with the same 1.5-T machine and protocol, which consisted of STIR, DWI and DCE sequences. Based on TIL score, BCs were stratified into two groups: absent-low TIL (≤ 10%) and medium-high TIL (> 10%). The t test was used to correlate mean ADC value with TIL groups. Receiver operating characteristic curve and Youden index were used in order to identify ADC value threshold to distinguish the two TIL groups. RESULTS: BC patients with absent-low TIL level and medium-high TIL one were, respectively, 66 (52.8%) and 59 (47.2%). Mean ADC value was 1.05 ± 0.19 * 10-3 mm2 s-1. Absent-low TIL group showed a lower mean ADC value than medium-high TIL one (0.96 ± 0.18 * 10-3 mm2 s-1 vs 1.14 ± 0.16 * 10-3 mm2 s-1; p < 0.0001). ADC value threshold in order to distinguish the two TIL groups with maximum sensitivity (67.8%) and specificity (80.3%) was 1.03 * 10-3 mm2 s-1. ADC value was shown to be significantly related to TILs level (p < 0.0001) and cancer histotype (p = 0.0006), with a lower mean ADC value correlated to absent-low TIL level and ductal histotype. CONCLUSION: BCs with absent-low TIL showed a statistically significant lower mean ADC value than those with medium-high TIL. ADC value threshold in order to distinguish these two groups was 1.03 * 10-3 mm2 s-1.

Contrast-enhanced ultrasound in the evaluation of splenic injury healing time and grade.

AIMS: To assess mean healing time of blunt spleen injuries managed nonoperatively using CEUS (contrast-enhanced ultrasound); to analyze whether spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct after spleen artery angioembolization could be related to healing time; and to evaluate CEUS sensitivity in diagnosing spleen injury and to assess CEUS performance in classifying spleen injury grade compared to CT. MATERIALS AND METHODS: After CT evaluation in the Emergency Department, 101 hemodynamic stable blunt spleen trauma patients (73 males; 28 females; mean age 46.4 years, range 18-92) underwent serial CEUS follow-up examinations at pre-established intervals (1, 3, 8, 15, 30, 60, 90 and 180 days after trauma), until spleen injury became no more identifiable. RESULTS: Mean CEUS examinations performed before spleen injury healing were 4.5; mean spleen injury healing time was 22.6 days. Spleen injury healing time was significantly related to spleen injury grade, subcapsular hematoma (SCH) presence, SCH grade and spleen infarct. CEUS spleen injury diagnostic sensitivity was 96.9% and, according to the American Association for the Surgery of Trauma (AAST)-spleen injury scale (SIS), CEUS-CT concordance was 95.8%. CONCLUSIONS: Spleen injury healing time in blunt abdominal trauma nonoperatively managed is significantly related to AAST-SIS grade, SCH presence and grade, and spleen infarct development, and CEUS can be used in order to evaluate spleen injury grade.

Radiation dose and image quality with new protocol in lower extremity computed tomography angiography.

PURPOSE: To compare radiation dose and image quality of lower extremity computed tomography angiography (CTA) between cranio-caudal acquisition with single-source CT (SSCT) and flash caudo-cranial acquisition with dual-source CT (DSCT). MATERIALS AND METHODS: In this prospective study, 60 patients were randomly assigned to Group A (control) or Group B (experimental) to undergo lower extremity CTA for peripheral obliterative arterial disease. Group A received protocol 1 (P1) with SSCT cranio-caudal acquisition. Group B received protocol (P2) with DSCT flash caudo-cranial acquisition. Intravascular attenuation (IVA), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image noise were compared. Two radiologists assessed the image quality. Computed tomography volume dose index (CTDIvol) and dose-length product (DLP) were also compared. RESULTS: IVA with P2 was higher than with P1 (586.8 ± 140.3 vs. 496.1 ± 129.3 HU, p = 0.011), as was SNR (33.0 ± 11.3 vs. 27.4 ± 12.3; p = 0.042), CNR (30.1 ± 13.3 vs. 24.2 ± 10.3; p = 0.029) and image quality score of small arteries below the knee (3.8 ± 0.2 vs. 3.1 ± 0.2; p = 0.001). Radiation dose was significantly lower in P2 than in P1 with CTDIvol reduction of 40.9% (1.3 ± 0.1 vs. 2.2 ± 0.3 mGy; p = 0.006) and DLP reduction of 42.8% (148.7 ± 21.9 vs 260.2 ± 59.1 mGy * cm; p = 0.018). CONCLUSION: Lower extremity CTA with DSCT flash caudo-cranial acquisition allows lower radiation dose with higher IVA, SNR, CNR and better image quality for small arteries below the knee than SSCT cranio-caudal acquisition.

Role of DCE-MR in predicting breast cancer subtypes.

OBJECTIVE: The purpose of this retrospective study is to find a correlation between dynamic contrast-enhanced MR features with histological, immunohistochemical and loco-regional characteristics of breast cancer. MATERIALS AND METHODS: A total of 149 patients with histopathologically confirmed invasive breast carcinoma underwent MR imaging. Histological analysis included: histological features (histological type, necrosis, vascular invasion and Mib-1), immunohistochemical characterization (immunophenotype, receptor status, HER2-neu and grading) and loco-regional characteristics (T and N). The kinetic MR features analyzed were: curve type, maximum enhancement, time to peak, wash-in and wash-out rate, brevity of enhancement and area under curve. RESULTS: MRI kinetic parameters and immunohistological features were compared using chi square test, two-tailed student t test and Anova test, with p = 0.05 level of significance. Vascular invasion was shown to be significantly related to time to peak (p = 0.02). The immunohistotype was shown to be significantly related with maximum enhancement (p = 0.05), time to peak (p = 0.04) and wash-in rate (p = 0.01). ER status correlates with maximum and relative enhancement (p = 0.004 and p = 0.028), wash-in rate (p = 0.0018) and area under curve (p = 0.006). PR status was significantly related to time to peak (p = 0.048) and wash-in rate (p = 0.05). CONCLUSION: Maximum enhancement absolute and relative, time to peak, wash-in rate and area under the curve significantly correlate with several prognostic factors, like ER status, immune profile and tumoral vascular invasion, and may predict the aggressiveness of the tumor.

Rupture of the cavernous body diagnosed by contrast-enhanced ultrasound: Presentation of a clinical case.

Penile trauma represents a urological emergency characterized by the breaking of the albuginea tunic. A fast diagnosis and early surgical repair are the best treatments to avoid post-operative sequelae such as curvatures or deformities of the penis. An ultrasound evaluation may not be able to identify the injury in the tunica albuginea due to the edematous swelling of the penis and clots within the tear deteriorate the image contrast and can hide the injury. We here report a case study of successful management via surgical treatment for rupture of the cavernous body diagnosed by contrast-enhanced ultrasound in a young patient with penile trauma.

Role of Contrast-Enhanced Sonography in the Evaluation of Axillary Lymph Nodes in Breast Carcinoma: A Monocentric Study.

OBJECTIVES: To evaluate the diagnostic performance of contrast-enhanced sonography for characterization of the lymph node status (metastatic or not) in patients with breast carcinomas by comparison with sentinel lymph node biopsy. METHODS: From January to August 2015, 50 female patients with a histologic diagnosis of invasive breast carcinoma were prospectively examined by ipsilateral axillary contrast-enhanced sonography. The test was performed by a single radiologist using an ultrasound system with a broadband 8-12-MHz, 38-mm high-resolution linear transducer. For the target lymph node, we chose a node with a sonographic pattern that was suspicious for malignancy: ie, a longitudinal-to-transverse diameter ratio of less than 2, absence of a central hyperechogenic hilum, or both. In cases with a lack of sonographic signs of malignancy, we evaluated the node with the maximal transverse diameter. Nodes were considered malignant in cases with total absence of contrast enhancement and in those with enhancement alterations. Within 1 week, all patients underwent sentinel lymph node biopsy, followed by a histologic test. RESULTS: The histologic test showed benignity in 22 of 50 sentinel lymph nodes, whereas 28 were metastatic. Among the 22 patients with negative biopsy results, contrast-enhanced sonography showed 18 concordances and 4 false-positives results; among the 28 with positive biopsy results, contrast-enhanced sonography obtained 100% correct characterizations of the axillary status. The sensitivity, specificity, and accuracy were 100%, 82%, and 92%, respectively. CONCLUSIONS: Contrast-enhanced sonography appears to be a method with high accuracy for characterization of axillary lymph nodes, very close to the reference-standard sentinel lymph node biopsy. This technique seems to have overall high sensitivity.

Chromium exposure and germinal embryonal carcinoma: first two cases and review of the literature.

The aim of the study was to determine the potential role of occupational exposures to chromium (Cr) in the onset of extragonadal germinal embryonal carcinoma. The first two cases of workers in a company with Cr exposure are reported. The published scientific literature regarding the topic in peer-reviewed journals including MEDLINE and CancerLit databases was extensively reviewed. Two young patients who were coworkers in the same company, exposed to Cr, developed extragonadal germinal embryonal carcinomas. One of them also developed angiosarcoma of the mediastinum. To the best of our knowledge these are the first two cases of germinal embryonal carcinoma in patients with occupational exposure to Cr.

Utility of an open-source DICOM viewer software (OsiriX) to assess pulmonary fibrosis in systemic sclerosis: preliminary results.

To investigate the utility of an open-source Digital Imaging and Communication in Medicine viewer software-OsiriX-to assess pulmonary fibrosis (PF) in patients with systemic sclerosis (SSc). Chest high-resolution computed tomography (HRCT) examinations obtained from 10 patients with diagnosis of SSc were analysed by two radiologists adopting a standard semiquantitative scoring for PF. Pulmonary involvement was evaluated in three sections (superior, middle and inferior). For the assessment of the extension of PF, the adopted semiquantitative HRCT score ranged from 0 to 3 (0 = absence of PF; 1 = 1-20 % of lung section involvement; 2 = 21-40 % of lung section involvement; 3 = 41-100 % of lung section involvement). Further, a quantitative assessment (i.e. parameters of distribution of lung attenuation such as kurtosis and mean lung attenuation) of PF was independently performed on the same sections by a rheumatologist, independently and blinded to radiologists' scoring, using OsiriX. The results obtained were compared with those of HRCT semiquantitative analysis. Intra-reader reliability of HRCT findings and feasibility of OsiriX quantitative segmentation was recorded. A significant association between the median values of kurtosis by both the quantitative OsiriX assessment and the HRCT semiquantitative analysis was found (p < 0.0001). Moreover, kurtosis correlated significantly with the mean lung attenuation (Spearman's rho = 0.885; p = 0.0001). An excellent intra-reader reliability of HRCT findings among both readers was obtained. A significant difference between the mean time spent on the OsiriX quantitative analysis (mean 1.85 ± SD 1.3 min) and the mean time spent by the radiologist for the HRCT semiquantitative assessment (mean 8.5 ± SD 4.5 min, p < 0.00001) was noted. The study provides the new working hypothesis that OsiriX may be a useful and feasible tool to achieve a quantitative evaluation of PF in SSc patients.

Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size.

BACKGROUND/OBJECTIVE: The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS: Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). RESULTS: Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS: Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.

Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report.

We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.

The P.I.N.K. Study Approach for Supporting Personalized Risk Assessment and Early Diagnosis of Breast Cancer.

Breast cancer is a clear example of excellent survival when it is detected and properly treated in the early stage. Currently, screening of this cancer relies on mammography, which may be integrated by new imaging techniques for more exhaustive evaluation. The Personalized, Integrated, Network, Knowledge (P.I.N.K.) study is a longitudinal multicentric study involving several diagnostic centres across Italy, co-ordinated by the Italian National Research Council and co-funded by the Umberto Veronesi Foundation. Aim of the study is to evaluate the increased diagnostic accuracy in detecting cancers obtained with different combinations of imaging technologies, and find the most effective diagnostic pathway matching the characteristics of an individual patient. The study foresees the enrolment of 50,000 women over the age of 40 years presenting for breast examination and providing informed consent to data handling. So far, the 15 participating centres across Italy have recruited a total of 22,848 patients. Based on the analyses of the first 175 histopathological-proven breast cancers, mammographic sensitivity was estimated to be 61.7% (n = 108 cancers), whereas diagnostic accuracy increased by 35.5% (n = 44 cancers) when mammography was integrated with other imaging modalities (ultrasound and/or digital breast tomosynthesis). Increase was mainly determined by ultrasound alone. Given the ongoing data collection and recruitment, the number of cancers detected is too low to allow any further in-depth analysis to explore links to patient characteristics. Past studies show that the uniform approach of population screening guidelines should be revised in favour of more personalised regimens, where known standards are integrated by imaging techniques most suitable for the individual's characteristics. With the ultimate goal of identifying early breast cancer detection strategies, our preliminary results suggest that integrated diagnostic approach could lead to a paradigm shift from an age-based regimen toward more specific and effective risk-based personalised screening regimens, in order to reduce mortality from breast cancer.

Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy.

PURPOSE: The main aim of the study was to assess if the mean apparent diffusion coefficient (ADC) value was significantly different between papillary lesions (PL) without atypia and PLs with atypical or malignant foci. A secondary objective was to evaluate if patients mean age, MRI BI-RADS® descriptors and assessment category were significantly different between these two PL groups. METHODS: In this eight year retrospective study were included 122 patients (mean age, 51 years; range, 24-78) with 122 PLs without atypia at micro-histological examination after core needle biopsy (CNB) performed under sonographic guidance. All patients underwent surgical excision biopsy within 3 months after CNB. All patients underwent MRI examination before surgical excision, including STIR, DWI and Dynamic Contrast-Enhanced sequences. RESULTS: Mean ADC value difference between PLs without and with atypia or malignant foci was statistically significant (p < 0.0001). Mean ADC value optimal threshold in order to distinguish the two groups was 1.418 × 10-3 mm2/s. A mean ADC value ≤ 1.418 × 10-3 mm2/s could predict atypical or malignant foci within a PL with 83.9% sensitivity and 75.8% specificity. No statistically significant difference was found with regard to patients mean age, MRI BI-RADS® descriptors and assessment category between these two PL groups. CONCLUSIONS: Mean ADC value of PLs without atypia at CNB is an efficient tool in order to help distinguish between PLs without and with atypical or malignant foci at final pathology on surgical excision, and it could be used to help decide how to manage these lesions.

Contrast-enhanced ultrasound evaluation of testicular syphilis: a case report.

In North America and Europe, syphilis incidence has increased dramatically in the past decade among high-risk groups. Syphilis may occur in any organ, including the testis. There are not many cases of testicular syphilis assessed by means ofultrasound examination described in the literature, and in no case was the evaluation carried out using advanced ultrasound techniques. Here we present a case of testicular syphilis evaluated by contrast-enhanced ultrasound.