Masses of the hand and wrist: detection and characterization with MR imaging

To assess the value of MR imaging in the detection, delineation, and characterization of mass lesions of the hand and wrist, we reviewed the MR imaging findings of 38 patients referred for evaluation of such lesions. Twenty-five patients had a palpable mass. In an additional 13 patients an occult mass lesion was suspected as the cause of distal ulnar neuropathy. Twenty-two mass lesions (16 benign and six malignant) were detected by MR. All were correctly predicted to be benign or malignant. In nine (56%) of the 16 benign mass lesions, the specific diagnosis was suggested. In the remaining seven benign mass lesions and in the six malignant tumors, the MR findings were not specific enough to permit a diagnosis. Of the 14 patients referred for evaluation of a distal ulnar neuropathy, an occult ganglionic cyst compressing the ulnar nerve was revealed with MR imaging in three. MR imaging of the hand and wrist is accurate in the detection of mass lesions and can correctly distinguish benign from malignant tumors in the majority of cases. Specific diagnoses can be made in certain benign lesions. Occult mass lesions can be confirmed or excluded as the cause of distal ulnar neuropathy with MR imaging.     

Computed tomography of pleural lesions with special reference to the mediastinal pleura

Computed tomography (CT) and conventional chest radiography were reviewed in retrospect in 84 patients in whom pleural pathology was suggested clinically. The importance of administration of contrast medium in distinguishing between malignant lesions and other pleural diseases was given special attention. CT was found to be of value in diagnosing and establishing the extent of pleural lesions, especially in the mediastinal region. All malignancies exhibited high contrast enhancement following intravenous bolus injection of contrast medium. There were no features specific for mesotheliomas distinguishing these from other pleural malignancies. Some benign infectious lesions also showed high contrast enhancement. High contrast enhancement thus indicated malignancy only if an infectious lesion could be excluded. If contrast enhancement was absent or slight, the lesion was likely to be benign. Clinical follow-up may be regarded as justified in such cases. Indirect signs were not helpful in distinguishing between malignant and benign lesions.     

The role of scintimammography with 99mTc-sestamibi as a complementary diagnostic technique in the detection of breast cancer

Purpose: To prospectively determine the clinical value of scintimammography (Sc) with ^99mTc-sestamibi as a complementary method to triple diagnosis (TD) in detecting malignant disease of the breast.Material and Methods: Ninety-six patients with 119 clinically or mammographically detected breast lesions underwent TD procedures, including clinical examination, mammography and fine-needle aspiration cytology. Prone planar Sc with ^99mTc-sestamibi was performed in all 96 patients. Five groups were defined for diagnosis: 1=normal; 2=benign; 3=probably benign; 4=highly suspect of malignancy; and 5=malignant. All lesions were histopathologically examined. The results of each method per se and the combination of TD with Sc (TD+Sc) were analyzed.Results: Histopathology of the 119 surgically excised breast lesions found 83 malignant and 36 benign lesions. TD missed 6 of 83 carcinomas, resulting in a sensitivity of 92.7%. Sc alone showed sensitivity of 85.5%. The combination TD+Sc missed 1 of 83 carcinomas, and thus had a sensitivity of 98.7%. In mammographically dense breasts both TD and Sc detected 16 of 18 carcinomas, while the combination TD+Sc led to detection of all 18 carcinomas.Conclusion: Adding Sc to TD increases the sensitivity for detection of breast carcinomas. Sc with ^99mTc-sestamibi is recommended as a complimentary method to TD in selected cases such as mammographically dense breasts.     

Pharmacokinetic Analysis of Gd-DTPA Enhancement in dynamic three-dimensional MRI of breast lesions

The purpose of this study was to demonstrate that dynamic MRI covering both breasts can provide sensitivity for tumor detection as well as specificity and sensitivity for differentiation of tumor malignancy. Three-dimensional gradient echo scans were used covering both breasts. Before Gd-DTPA bolus injection, two scans were obtained with different flip angles, and after injection, a dynamic series followed. Thirty-two patients were scanned according to this protocol. From these scans, in addition to enhancement, the value of T1 before injection was obtained. This was used to estimate the concentration of Gd-DTPA as well as the pharmacokinetic parameters governing its time course. Signal enhancement in three-dimensional dynamic scanning was shown to be a sensitive basis for detection of tumors. In our series, all but two mam-mographically suspicious lesions did enhance, and in three cases, additional enhancing lesions were found, two of which were in the contralateral breast. The parameter most suited for classification of breast lesions into benign or malignant was shown to be the pharmacokinetically defined permeability k₃₁, which, for that test, gave a sensitivity of 92% and a specificity of 70%. Our three-dimensional dynamic MRI data are sensitive for detection of mammographically occult breast tumors and specific for classification of these as benign or malignant.     

Bronchography in patients with suspected lung malignancy

Bronchography and flexible fiberoptic bronchoscopy (FFB) were performed on 95 patients with suspected lung malignancy. Finally, 66 of 95 lesions turned out to be malignant and 29 benign. Bronchographic diagnosis was correct in 46 of 66 cases of cancer (70%) but gave a false negative result in 20 malignant lesions and a false positive result in four benign lesions of which three had pulmonary tuberculosis and one hamartoma of the lung. It is concluded that bronchography is rarely indicated in central malignant lesions. In peripheral lesions bronchographic findings for malignancy are unreliable or negative.     

Incidental findings on sonography of the breast: clinical significance and diagnostic workup.

OBJECTIVE: The purpose of this study was to determine how often physician-performed high-resolution sonography can detect nonpalpable breast lesions not revealed by mammography. A sonographic classification scheme was tested for its accuracy in predicting malignancy of incidentally detected breast lesions. SUBJECTS AND METHODS: Six thousand one hundred thirteen asymptomatic women with breast density grades 2-4 and 687 patients with palpable or mammographically detected breast masses underwent sonography as an adjunct to mammography. All sonographically detected, clinically and mammographically occult breast lesions that were not simple cysts were prospectively classified into benign, indeterminate, or malignant categories. Diagnoses were confirmed by sonographically guided fine-needle aspiration or core needle biopsy. RESULTS: In 6113 asymptomatic women, 23 malignancies in 21 patients were detected with sonography only (prevalence, 0.31%). Five additional malignant lesions were found in patients with a malignant (n = 3) or a benign (n = 2) palpable or mammographically detected index lesion. The mean size of invasive malignancies detected only by sonography was 9.1 mm, which was not significantly different from the mean size of invasive cancers detected by mammography (p = .07). The sensitivity of the prospective sonographic classification for malignancy was 100%, and the specificity was 33.5%. CONCLUSION: The use of high-resolution sonography as an adjunct to mammography in women with dense breasts may lead to detection of a significant number of otherwise occult malignancies that are no different in size from nonpalpable mammographically detected lesions. Prospective classification of these lesions based on sonographic characteristics results in a significant reduction in number of unnecessary biopsies performed.     

26. Incidental findings should be included in the analysis of cost-effectiveness for evaluation of pulmonary nodules by FDG-PET

Background: In cost-effective analysis regarding to utilization of FDG-PET on lung nodules, most studies focused on lung lesions themselves (benign vs. malignant) and possible metastases if primary lesion is malignant. However, in a patient with pulmonary nodules, abnormal sites of increased FDG uptake on a whole-body PET scan may either the primary tumor or lesions unrelated to lung malignancy. The incidence of detection of the unsuspected lesions, which often changes the management of these patients, should also be included in the cost-effective analysis.Methods: We retrospectively analyzed 213 cases referred for evaluation of pulmonary nodules. 89 of them proved to have lung malignancy and were excluded in our study. None of the remaining 124 patients had prior clinical or radiographic evidence of other abnormalities before undergoing FDG-PET. All unsuspected lesions were verified either histologically or by the clinical course of the disease.Results: Among the 124 patients without lung cancer, FDG-PET revealed unsuspected abnormality in eight patients. These include other malignancy (colon cancer x 3, lymphoma x 1) and benign lesions (sarcoidosis x 3, cystic kidney x 1). None of the 124 patients studied had additional pathology found during follow-up.Conclusion: The routine uses of FDG-PET for characterizing the lung lesions significantly increases the chances detecting unexpected other pathology. The incidental FDG-PET findings of unsuspected lesions, especially those unrelated to lung cancers, no doubt have a major impact on the management of these patients and may prove to be cost-effective.     

结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会

目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议.方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI.动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类.结合X线与MRI分类提出新的良恶性评估法.统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率.结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好.166个肿块,恶性41个,占24.7％.X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个.X线BI-RADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个.X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个.X线诊断敏感度、特异度为70.7％、74.4％,诊断符合率为73.5％.MRI诊断敏感度、特异性及诊断符合率为95.1％、79.2％和83.1％.X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P＜0.05).新的良恶性评估法发现乳腺癌的敏感度为100％,诊断符合率为77.7％,良性病变检出率为53.0％.结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值.结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检.     

Soft tissue masses in the foot and ankle: characteristics on MR Imaging

Benign neoplasms and tumor-like lesions constitute the majority of soft tissue masses in the foot and ankle. Therefore, malignant tumors are often unsuspected at this site and misdiagnosed clinically, especially if occurring in young individuals with unspecific or long-standing clinical symptoms. In addition to radiography, MR imaging represents the method of choice in evaluation of foot tumors. Because of their relatively characteristic imaging appearance, in most cases of benign soft tissue lesions of the foot and ankle a specific diagnosis can be suggested. Unfortunately, malignant tumors can also arise with nonaggressive imaging features. Diagnostic errors can be avoided if any soft tissue lesion that cannot be specifically diagnosed is regarded as potentially malignant until proved otherwise. This article reviews the MR appearance of the most common benign and malignant soft tissue masses in the foot and ankle together with their clinical, radiographic, and pathological findings.     

腮腺造影CT扫描的评价

目的:探讨CTS对腮腺肿块的诊断价值。材料与方法:50例腮腺区肿块,其中46例经手术病理证实,4例经临床消炎治疗证实,均做了CT平扫与增强扫描及CTS扫描,对CT与CTS表现结合病理进行分析。结果:一、CT示33例恶性征象结节灶与团块灶,CTS示17例为局限炎性肿块,15例腺内恶性肿瘤,1例腺外横纹肌肉瘤,手术病理证实1例粘膜相关淋巴瘤误为炎性肿块。二、CT示12例良性肿瘤征象。CTS示11例为良性肿瘤,1例恶性肿瘤,有2例误为良性肿瘤,手术病理证实是腺样囊性癌和腺内淋巴结核。结论:CTS对腮腺局限炎性肿块与恶性肿瘤的鉴别比CT及其它影像有独特的优势,对良恶性肿瘤的鉴别有重要价值,且有进一步组织学定性的意义。     

Primary tumors of the patella

This study reports 42 cases of histologically proven and radiographically correlated primary patellar tumors. Despite diverse histologic diagnoses, the radiographic appearances of benign as opposed to malignant patellar neoplasms are essentially indistinguishable. Although the literature suggests that giant cell tumor is the most frequent benign tumor of the patella, the most common benign neoplasm in this series is chondroblastoma (16 cases). Only four primary malignant lesions were encountered, three cases of lymphoma and one case of hemangioendothelioma. Since 38 (90%) of the 42 cases were benign, a benign etiology should be strongly favored, notwithstanding the radiographic appearance, whenever a primary patellar tumor is encountered.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

良恶性肿瘤18F-FDG符合线路显像的临床价值

目的 评价18F-FDG符合线路显像检测良恶性肿瘤的诊断价值.方法 回顾性分析135例病变性质不明患者的18F-FDG符合线路显像结果,并与常规影像学检查结果进行对比分析.病变的确诊依据手术病理检查和临床随诊.结果 135例患者经病理学检查及随访结果最终确诊为恶性病变者86例(病灶数:95个),良性病变者49例(病灶数...     

Effects of fine-needle aspiration on the US appearance of the breast.

Fine-needle aspiration (FNA) of normal breast tissue or benign lesions can cause changes that suggest malignancy at ultrasound (US) examination. Serial US studies showed that three of 17 patients developed signs mimicking malignancy following FNA of palpable breast lumps. A second group of 14 patients had US signs of malignancy in palpable lumps following recent FNA. Nine patients with benign lesions were unnecessarily worried, since the appearance was probably due to FNA. Diagnosis of malignancy was delayed in one of five patients because the US appearance was attributed to the FNA in the presence of false-negative cytologic findings. FNA of normal breast tissue or benign masses produced tissue changes in 18% of cases that altered the US appearance from normal or benign to possibly malignant. The changes took up to 4 months to subside. If US is clinically indicated, it should be performed before FNA.     

Fine-needle aspiration of breast biopsy specimens: correlation of histologic and cytologic findings.

The accuracy of fine-needle aspiration (FNA) cytologic diagnosis of nonpalpable breast lesions and the prevalence of neoplasm occurring in areas unrelated to the radiologic abnormality were studied. Template-guided FNA cytologic examination was performed in 101 surgically excised breast specimens. The exact area of the mammographic abnormality was aspirated with radiographic control. Despite accurate placement of the needle for aspiration, seven of 101 aspirates (7%) yielded insufficient cytologic material. Ninety-four of the 101 aspirates (93%) were adequate for diagnosis. The cytologic diagnosis was benign in 58 (62%), atypical in seven (7%), suspicious for malignancy in four (4%), and malignant in 25 (27%). All cases diagnosed as suspicious or malignant and five of 58 cases diagnosed as benign at cytologic examination proved to be malignant at histologic examination. In three of these five the malignancy was in the area of the radiologic abnormality; in two it was not. FNA cytologic examination can be helpful in evaluating nonpalpable breast lesions, but it is not as accurate as histologic examination of surgically excised lesions.     

Computed tomographic mammography (CTM).

Breasts of 724 patients were studied by physical examination, mammography, and computed tomographic mammography (CTM) using a scanner designed for evaluation of the breast. Among cases in which CTM was not accompanied by use of contrast material, there were 60 malignant lesions, of which 10% were missed by mammography, 32% by CTM, and 8% by both. Among cases where CTM was supplemented by a 50 ml injection of 75% contrast material, there were 63 malignant lesions, of which 14% were missed by mammography, 16% by CTM, and 3% by both. Among cases where CTM was supplemented by a 300 ml infusion of 30% contrast material, there were 41 malignant lesions, of which 7% were missed by mammography and 5% by CTM, but none by both. Clinically, 22% of the malignant lesions in the infusion series were occult. There were 44 benign lesions in patients studied with the infusion technique. With mammography 68% were suspicious for malignancy, and with CTM, 56%.     

FDG–PET imaging findings of a pulmonary sclerosing hemangioma

Pulmonary sclerosing hemangiomas are generally regarded as benign lung lesions arising from type II pneumocytes and bronchial epithelium. In some cases malignant features may be present. There are several case reports describing the radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics of pulmonary sclerosing hemangiomas. Given the potential for low-grade malignancy 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging may be useful in the diagnostic work up and therapeutic planning in these patients, however the FDG–PET imaging features of pulmonary sclerosing hemangiomas are not well defined. We report a case of histopathologically diagnosed sclerosing hemangioma of the lung which demonstrated intermediate uptake of FDG on the preoperative PET/CT evaluation.     

术前超声及钼靶BI-RADS分类对早期乳腺癌的诊断价值

 目的 探索术前超声及钼靶BI-RADS分类对早期乳腺癌的诊断价值。方法 收集2015-08至2017-08在医院确诊为早期乳腺癌(TNM分期为Ⅰ、Ⅱ期)且术前同时行超声及钼靶检查的43例患者资料,共44个病灶。以BI-RADS分类≤3判为良性,=4a为可疑恶性,≥4b判为恶性,回顾性分析超声、钼靶及两者联合对早期乳腺癌的诊断价值。结果 早期乳腺癌术前超声BI-RADS分类判为可疑恶性及恶性的比例为93.2%(41/44),明显高于钼靶75.0%(33/44),差异有统计学意义(P＜0.05),两者联合诊断比例为95.5%(42/44)。其中对于黏液腺癌,超声判读为可疑恶性及恶性的比例明显高于钼靶,而浸润性导管癌、导管内癌及其他类型乳腺癌超声与钼靶BI-RADS分类无差异。其中两者联合仍判为良性的2个病灶分别为导管内癌和髓样癌。结论 对于早期乳腺癌尤其是黏液腺癌,术前超声BI-RADS分类判为可疑恶性及恶性的比例较钼靶更高;术前超声和钼靶判为可疑恶性及恶性的比例与乳腺癌病理类型密切相关;而对于特殊类型的早期乳腺癌及导管内癌两者结合仍有可能漏诊。     

Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation

PURPOSE: To determine the sensitivity and specificity of computed tomographic (CT) criteria for differentiating benign from malignant stomach lesions in patients with a thickened gastric wall at CT. MATERIALS AND METHODS: A radiology department file search revealed 36 patients with a thickened gastric wall at CT who underwent double-contrast barium suspension upper gastrointestinal tract examinations within 6 weeks before or after CT. The authors reviewed the CT images without knowledge of the final radiologic, endoscopic, or pathologic findings to determine the degree of gastric wall thickening and the symmetry, distribution, and enhancement of the thickened wall. The sensitivity and specificity of these findings for detection of malignancy were calculated. RESULTS: Two of 36 patients had two gastric abnormalities each. The final diagnoses in the 38 cases were gastritis in 19, hiatal hernia in four, benign ulcer in three, benign (n = 3) or malignant (n = 8) gastric neoplasm in 11, and no gastric abnormality in one case. Mean wall thickness was 1.5 cm (range, 0.7-7.5 cm). The finding of gastric wall thickness of 1 cm or greater had a sensitivity of 100% but a specificity of only 42% for detection of malignant or potentially malignant stomach lesions. The finding of focal, eccentric, or enhancing wall thickening had a sensitivity of 93%, 71%, or 43%, respectively, and a specificity of 8%, 75%, or 88%, respectively, for detection of these lesions. Gastric wall thickening that was 1 cm or greater and was focal, eccentric, and enhancing had a specificity of 92% but a sensitivity of only 36% for detection of these lesions. CONCLUSION: Gastric wall thickness of 1 cm or greater at CT had a sensitivity of 100% but a specificity of less than 50% for detection of malignant or potentially malignant stomach lesions that necessitated further diagnostic evaluation.     

MRI在良、恶性胸膜肿瘤鉴别诊断中的价值

目的：探讨磁共振成像在良、恶性胸膜肿瘤鉴别诊断中的作用。方法：对45例胸膜肿瘤患者（良性8例,恶性37例）进行了CT和MRI检查。评估分析良、恶性胸膜肿瘤的CT和MRI形态学特点及其分别在T1WI、T2WI和增强T1WI上的信号特点。结果：在CT图像上,共出现弥漫性胸膜增厚30例（恶性29例,良性1例）,纵隔胸膜受累28例（恶性27例,良性1例）、环绕或不规则胸膜增厚23例（恶性22例,良性1例）,胸壁或膈肌浸润9例（全部为恶性）;在MRI上,共出现弥漫性胸膜增厚32例（恶性31例,良性1例）,纵隔胸膜受累29例（恶性27例,良性2例）、环绕或不规则胸膜增厚24例（恶性23例,良性1例）,胸壁或膈肌浸润1例（全部为恶性）。根据前述形态学特点,CT与MRI对诊断胸膜恶性肿瘤总的敏感性分别为83．8％和86．5％,总特异性均为62．5％。结论形态学及信号特点,MRI对诊断良、恶性肿瘤病变的敏感性为97．3％,特异性为100％。结论：单纯依据其形态学特点,MRI对胸膜肿瘤的发现与诊断价值与CT相仿。但当MR信号与形态学特点结合时,其对良、恶性胸膜肿瘤的鉴别诊断价值则明显优于CT。     

Follow-up of benign results of stereotactic core breast biopsy

RATIONALE AND OBJECTIVES: The purpose of this study was to obtain long-term follow-up data on women with benign histologic results of a breast stereotactic core needle biopsy (CNB). MATERIALS AND METHODS: Mammography charts of 300 consecutive women who underwent prone stereotactic CNB with digital radiography were reviewed. Women with frankly malignant or suspicious histologic findings (51 patients) or a technically unsuccessful stereotactic CNB (one patient) were excluded. The remaining 248 benign core biopsies in 229 women were included in the study. RESULTS: Follow-up mammograms were obtained for 152 lesions with benign histologic results following stereotactic CNB. The mean length of follow-up after stereotactic CNB was 34.6 months. Cancer was diagnosed in six women who underwent surgical biopsies 1/2 to 30 months after benign stereotactic CNB. An initial chart review demonstrated that no follow-up data were available for 64 lesions, and information was missing for an additional seven. CONCLUSION: SCNB remains a sampling procedure that can result in false-negative histologic results. Intrinsic procedural issues were identified that could minimize the potential for missing a malignancy. Goals for patient compliance with follow-up recommendations fell short of expectations.