MRI patterns of invasive lobular breast cancer.

Dr. Schelfout and colleagues, in the March 2004 issue of European Radiology described six tumor morphologic patterns of invasive lobular breast cancer. We retrospectively compared findings on preoperative MR imaging in 18 patients with invasive lobular cancer performed at our institution and we found an additional morphologic pattern in our population: a mass with regular margins (five cases).

CT cross-sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach.

BACKGROUND: The purpose of this study was to identify risk factors for surgical extracervical approach in patients with substernal goiter. We used a novel classification system based on CT scan cross-sectional imaging (CSI) reconstruction. METHODS: Medical records of 4297 patients with thyroid disease operated on at our department were reviewed. A CSI classification system defined substernal goiter in the cranio-caudal dimension as: grade 1 (above aortic arch), grade 2 (level of aortic arch), and grade 3 (below aortic arch); in the anteroposterior dimension as type A (prevascular), type B (retrovascular-paratracheal), and type C (retrotracheal); in the latero-lateral dimension as: monolateral or bilateral. RESULTS: The prevalence of substernal goiter was 222 of 4297 cases (5.1%). Fifteen of 222 cases (6.7%) required an extracervical approach due to grade ≥2 and/or type C substernal goiter (14 of 15 cases). Ten of 15 patients had malignancy. CONCLUSION: The CT-CSI classification system allows us to identify risk factors for extracervical surgical approach in substernal goiter. They are grade ≥2, type C substernal goiter, and malignancy.

Ga-68 DOTATOC PET, endoscopic ultrasonography, and multidetector CT in the diagnosis of duodenopancreatic neuroendocrine tumors: a single-centre retrospective study.

PURPOSE: In this report, we compared endoscopic ultrasonography (EUS), multidetector CT (MDCT), and Ga-68 DOTATOC PET/CT in patients with neuroendocrine tumors (NETs). We report our experience with use of these methods in patients suspected to have duodenopancreatic primitive NET. METHODS: Nineteen consecutive patients (mean age, 56; 21-80), who underwent both Ga-68 DOTATOC PET/CT and EUS between March 2007 and November 2008 were retrospectively included in the study (16 underwent MDCT). Suspicion of NET was confirmed by EUS-FNA and/or surgery. Operative characteristics of PET, EUS, and MDCT were compared. RESULTS: Twenty-three neuroendocrine lesions were diagnosed in 13/19 patients. EUS, PET, and MDCT correctly identified as affected 13/13 (100%), 12/13 (92%), and 10/11 (91%) patients, respectively. On a lesion basis, EUS, PET, and MDCT identified correctly as NETs 22/23 (96%), 20/23 (87%), and 13/18 (72%) lesions (P = 0.08 EUS vs. CT). Both on a patient and on a lesion basis, specificity was 67%, 83%, and 80% for EUS, PET, and MDCT, respectively. CONCLUSIONS: EUS, Ga-68 DOTATOC PET, and MDCT seem to have comparable accuracy in diagnosis of duodenopancreatic NET and their combination may allow an optimal preoperative diagnosis.

A filmless radiology department in a full digital regional hospital: quantitative evaluation of the increased quality and efficiency.

Reggio Emilia hospital installed Picture Archiving and Communications Systems (PACS) as the final step towards a completely digital clinical environment completing the HIS/EMR and 1,400 web/terminals for patient information access. Financial benefits throughout the hospital were assessed upfront and measured periodically. Key indicators (radiology exam turnaround time, number of radiology procedures performed, inpatients length of stay before and after the PACS implementation, etc.) were analyzed and values were statistically tested to assess workflow and productivity improvements. The hospital went "filmless" in 28 weeks. Between the half of 2004 and the respective period in 2003, overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay. Neurology alone experienced a 12% improvement in average patient stay. To quantify the impact of PACS on the average hospital stays and the expected productivity benefits to inpatient productivity were used a "high level" and a "detailed" business model. Annual financial upsides have exceeded $1.9 millions/year. A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits. Staff buy-in was the key in this process and on-going training and process monitoring are a must.

Carotid and vertebral artery dissection: Magnetic Resonance findings in 15 cases.

PURPOSE: Spontaneous dissection of the carotid and vertebral arteries represents a rare pathology. Its pathogenesis, probably multi-factorial, can be related to neck trauma and to a genetic basis, extensively demonstrated in the cases of association with type IV fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan's syndrome, pseudoxanthoma elasticum and osteogenesis imperfecta. Onset symptoms include neck, facial pain and diffuse headache. Cranial nerve palsy has been also described. The aim of this study was to evaluate MR angiography and MR findings in a population of patients with carotid and vertebral artery dissections. MATERIALS AND METHODS: We reviewed the MR angiography and MR exams of 15 patients (10 males, 5 females, average age 42.0, age range 30-55) with carotid and/or vertebral artery dissection; the serial MR follow-up studies were also examined. RESULTS: Twelve internal carotid arteries (ICA) showed the presence of an irregular stenosis; three of these showed complete occlusion. In two patients both ICA were involved. Six vertebral arteries (VA) showed irregular stenosis (only one patient suffered from both CI and VA dissection); in one case there was also a pseudoaneurysm of the VA. Follow-up studies showed vessel lumen re-opening in 5/11 ICA (one patient underwent vascular stent positioning) and in 3/6 VA. CONCLUSIONS: The present study confirms the usefulness of MR angiography and MR in the diagnosis and follow-up of patients with carotid and vertebral artery dissection.