Absolute reliability of five clinical tests for assessing hamstring flexibility in professional futsal players

ObjectivesTo examine the absolute reliability of five methods for estimating hamstring flexibility in professional futsal players.DesignAbsolute reliability laboratory study (k = 4).MethodsA total of 46 male futsal players (172.9 ± 4.5 cm; 69.7 ± 7.5 Kg) completed the study. All participants performed each measurement test twice in a randomized order on four different occasions. Absolute reliability was examined through typical percentage error, percentage change in the mean and intraclass correlations (ICC) as well as their respective confidence limits.ResultsThe findings showed high reliability for the sit and reach test (SRT) (4.48% typical error; 0.84% change in the mean, 0.95 ICC), toe touch test (TT) (5.89% typical error; 2.31% change in the mean, 0.89 ICC) and back-saver sit and reach test (BSSR) (3.73% typical error; 0.51% change in the mean, 0.97 ICC) compared to the passive straight leg raise test (PSLR) (7.6% typical error; 8.86% change in the mean, 0.77 ICC) and modified sit and reach test (MSR) (11.87% typical error; 7.64% change in the mean, 0.84 ICC) which showed moderate reliability.ConclusionsAn observed change larger than 6.72%, 7.55% and 5.59% for baseline SRT, TT and BSSR scores respectively would indicate that a real improvement in hamstring flexibility has occurred. In addition, the clinical reliability of PSLR and MSR are questioned and should be re-evaluated in future research studies.     

Reproducibility and criterion-related validity of the sit and reach test and toe touch test for estimating hamstring flexibility in recreationally active young adults

Objective1) to examine the test-retest reproducibility and criterion-related validity of the sit and reach test (SRT) and the toe touch test (TT) for estimating hamstring flexibility measured through the passive straight leg raise test (PSLR); and 2) to determine whether the SRT cut-off scores may be used for the TT test to identify participants in this sample of young healthy adults as having short hamstring flexibility.DesignTest-retest design.SettingControlled laboratory environment.Participants243 active recreationally young adults.Main outcome measuresParticipants performed the SRT, the TT test and PSLR twice in a randomized order with a 4-week interval between trials. Reproducibility was examined using typical percentage error (coefficient of variation [CV]) and intraclass correlation coefficient (ICC) as well as their respective confidence limits. Regression and Kappa correlation statistical analyses were performed to study the association of the SRT and TT test with the PSLR test and the 95% limits of agreement (LoA) between SRT and TT test were calculated to explore differences in the mean differences between these measurements.ResultsThe finding showed acceptable reproducibility measures for SRT (8.74% CV; 0.92 ICC), TT test (9.86% CV; 0.89 ICC) and PSLR (5.46% CV; 0.85 ICC). The SRT (R² = 0.63) and TT test (R² = 0.49) were significantly associated with PSLR. The 95% LoA between SRT and TT test reported systematic bias (2.84 cm) and wide 95% random error (±9.72 cm).ConclusionsReproducibility of SRT, TT test and PSLR is acceptable and the criterion-related validity of SRT and TT test is moderate. Furthermore, the SRT cut-off scores should not be used for TT test for the detection of short hamstring muscles.     

Comparison of lateral abdominal muscle thickness between weightlifters and matched controls

Objective

To compare lateral abdominal muscle thickness between weightlifters and matched controls.

Design

A case control study design.

Setting

University laboratory.

Subjects

16 female Thai national weightlifters and 16 matched controls participated in this study.

Main outcome measures

Ultrasound imaging with a 12-MHz linear array was used to measure the resting thickness of transversus abdominis (TrA), internal oblique (IO) and total thickness (Total) of lateral abdominal muscle (LAM) on the right side of abdominal wall. The absolute muscle thickness and the relative contribution of each muscle to the total thickness were determined.

Results

Weightlifters had significantly thicker absolute TrA and IO muscles than matched controls (p < 0.01). Further, the relative thickness of the IO was significantly greater in weightlifters than matched controls (p < 0.05).

Conclusions

The findings of this study suggest that routine Olympic style weight training among female weightlifters appears to result in preferential hypertrophy or adaptation of the IO muscle.     

Correlation of single leg vertical jump, single leg hop for distance, and single leg hop for time

Objectives

To determine the correlation among three functional tests: single leg vertical jump (SLVJ), single leg hop for distance (SLHD), and single leg hop for time (SLHT).

Design

Prospective correlational investigation.

Setting

University research laboratory.

Participants

Forty healthy men (n = 19) and women (n = 21) between the ages of 18 and 30 (23.9 ± 2.0 years).

Main outcome measures

SLVJ was measured using the Vertec. SLHD was measured using a standard tape measure. SLHT was measured over a 10-m course using a standard stopwatch.

Results

The strongest correlation was between SLHT and SLHD, −0.89 and −0.89 for dominant and non-dominant lower extremities (LE), respectively. The weakest pairwise correlation was between SLVJ and SLHT, −0.71 and −0.63 for dominant and non-dominant LE, respectively. The correlation between SLVJ and SLHD was 0.74 and 0.71 for dominant and non-dominant LE, respectively.

Conclusion

There is a strong correlation between SLHT and SLHD, suggesting that each test measures similar constructs of function, while the modest correlation between SLVJ and SLHT suggest these two tests do not measure the same functional components, and could be paired as outcome measures for the clinical assessment of lower extremity function.     

The effect of first ballet classes in the community on various postural parameters in young girls

Objective

To examine the effect of first season ballet classes in the community on the thoracic kyphosis (TK), lumbar lordosis (LL), hip external rotation (ER) and joint flexibility in young girls.

Design

Longitudinal single blinded cohort control study.

Setting

Institutional.

Participants

30 girls aged 6-9, recruited from the same primary school were divided equally into 2 groups: a group bi-weekly community ballet class and a sedentary control group.

Intervention

All girls were assessed prior to ballet classes (t₀), at the conclusion (t₁) (6 months), and approximately one year later (t_fu).

Main outcome measures

Beighton score for joint hyper-flexibility, peak of TK and LL, range of hip ER, ratio TK/LL, and individual’s height, weight and BMI.

Results

LL at t1 became greater in the ballet girls’ group (23.7°± 6) as opposed to the controls (19.5°±3.9) due to a decrease in LL in the controls from t0 to t1 (mean difference = −16.5°) (cut-off score = 3.45°) (p < 0.05). TK decreased from t0 to t1 in the ballet girls’ group (mean difference = −26.1°) and controls (mean difference = −31.3°) (cut-off score = 4.85°) (p < 0.05). Left hip ER decreased only in the controls from t0 to t1 (mean difference = −13.8°) (cut-off score = 5.43°) (p < 0.05). Beighton score at tfu was greater in the ballet girls’ group (6.1 ± 2.3) as opposed to the controls (4.4 ± 1.5) (p < 0.05).

Conclusions

First season ballet classes for young girls in the community can be associated with relatively greater LL, and left hip ER and joint hyper-flexibility.     

Patient dose during interventional neuroradiology procedures: Results from a multi-center study

Purpose

The purpose of this multicenter study was to determine the doses received by patients during interventional neuroradiology procedures and to consider establishing reference standards.

Materials and methods

A retrospective study of nine interventional neuroradiology departments was conducted. Seven diagnostic (cerebral and spinal angiography) and therapeutic (embolization and vertebroplasty) procedures were reviewed. For each procedure, three dosimetric parameters were recorded: dose-area product (DAP), fluoroscopy time, and number of images.

Results

Results showed interdepartment variations, up to four-fold for diagnostic procedures and seven-fold for therapeutic procedures. However, applying the 75th percentile method to the entire dataset, reference standards can be proposed for six types of procedures including diagnostic cerebral angiography (230 Gy cm²), follow-up selective cerebral angiography (80 Gy cm²), aneurysm embolization (350 Gy cm²), AVM embolization (440 Gy cm²). Reference standards are also proposed with regards to fluoroscopy time and number of images.

Conclusion

Such standards are useful for clinicians to evaluate and improve their practices.     

Systolic reconstruction in patients with low heart rate using coronary dual-source CT angiography

Objectives

The purpose of our study was to determine the relationship between the predictive factors and systolic reconstruction (SR) as an optimal reconstruction window in patients with low heart rate (LHR; less than 65 bpm).

Methods

391 patients (262 male and 129 female, mean age; 67.1 ± 10.1 years of age) underwent coronary CTA without the additional administration of a beta-blocker. Affecting factors for SR were analyzed in age, gender, body weight (BW), diabetes mellitus (DM), coronary arterial disease (CAD), ejection fraction (EF), systolic and diastolic body pressure (BP) and heart rate variability (HRV) during coronary CTA.

Results

In 29 (7.4%) of the 391 patients, SR was needed, but there was no apparent characteristic difference between the systolic and diastolic reconstruction groups in terms of gender, age, BW, DM, CAD and EF. In a multivariate analysis, the co-existence of DM [P < 0.05; OR, 0.27; 95% CI, 0.092-0.80], diastolic BP [P < 0.01; OR, 0.95; 95% CI, 0.92-0.98] and HRV [P < 0.01; OR, 0.98; 95% CI, 0.96-0.99] were found to be the factors for SR. In gender-related analysis, HRV was an important factor regardless of sex, but co-existence of DM affected especially for female and BP for male.

Conclusion

Especially in the patients with LHR who had a medication of DM, high HRV or high BP, SR, in addition to DR, was needed to obtain high-quality coronary CTA images.     

P magnetic resonance spectroscopy to measure in vivo cardiac energetics in normal myocardium and hypertrophic cardiomyopathy: Experiences at 3 T

Background

³¹P magnetic resonance spectroscopy (MRS) allows measurement of in vivo high-energy phosphate kinetics in the myocardium. While traditionally ³¹P cardiac spectroscopy is performed at 1.5 T, cardiac MRS at higher field strength can theoretically increase signal to noise ratio (SNR) and spectral resolution therefore improving sensitivity and specificity of the cardiac spectra. The reproducibility and feasibility of performing cardiac spectroscopy at 3 T is presented here in this study in healthy volunteers and patients with hypertrophic cardiomyopathy.

Methods

Cardiac spectroscopy was performed using a Phillips 3T Achieva scanner in 37 healthy volunteers and 26 patients with hypertrophic cardiomyopathy (HCM) to test the feasibility of the protocol. To test the reproducibility a single volunteer was scanned eight times on separate occasions. A single voxel ³¹P MRS was performed using Image Selected In vivo Spectroscopy (ISIS) volume localization.

Results

The mean phosphocreatine/adenosine triphosphate (PCr/ATP) ratio of the eight measurements performed on one individual was 2.11 ± 0.25. Bland Altman plots showed a variance of 12% in the measurement of PCr/ATP ratios. The PCr/ATP ratio was significantly reduced in HCM patients compared to controls, 1.42 ± 0.51 and 2.11 ± 0.57, respectively, P < 0.0001. (All results are expressed as mean ± standard deviation).

Conclusions

Here we demonstrate that cardiac ³¹P MRS at 3 T is a reliable method of measuring in vivo high-energy phosphate kinetics in the myocardium for clinical studies and diagnostics. Based on our data an impairment of cardiac energetic state in patients with hypertrophic cardiomyopathy is indisputable.     

MRI findings of pancreatic lymphoma and autoimmune pancreatitis: A comparative study

Purpose

To clarify whether there are differences in MRI findings between pancreatic lymphomas and autoimmune pancreatitis (AIP).

Materials and methods

MRI of 8 patients with pancreatic lymphomas and 21 patients with AIP were retrospectively reviewed. For multifocal pancreatic lymphomas (n = 2) and AIP (n = 4), the largest 2 lesions were evaluated. Ten pancreatic lymphomas and 25 AIP were compared on three bases: the signal intensity on T2-weighted images, internal homogeneity, and presence or absence of capsule-like rim. In 8 lymphomas and 19 AIP, the enhancement pattern on dynamic MRI was compared, as well.

Results

On T2-weighted images, pancreatic lymphomas comprised 5, 5 and 4 lesions with low (iso), slightly high, and moderately high intensity, respectively, while the numbers for AIP were 14, 10, and 1 (P < 0.01). Nine of 10 (90%) lymphomas appeared homogenous, and 11 of 25 (44%) AIP were homogenous (P < 0.05). A capsule-like rim was present in 9 of 25 (36%) AIP, but was not seen in lymphomas (P < 0.05). On dynamic MRI, 18 of 19 (94.7%) AIP showed persistent (n = 5) or delayed enhancement (n = 13), and 6 of 8 (75%) lymphomas showed low intensity without delayed enhancement (P < 0.001).

Conclusion

MRI findings for pancreatic lymphomas and AIP were significantly different, which may be helpful for the differential diagnosis of these two diseases.     

Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: Comparison with T2-weighted fast spin-echo MR imaging

Objective

To test interobserver variability of ADC measurements and compare the diagnostic performances of free-breathing diffusion-weighted (FBDW) with that of T2-weighted FSE (T2WFSE) MR imaging for differentiating between cavernous hemangiomas and untreated malignant hepatic neoplasms.

Materials and methods

Thirty-five patients with cavernous hemangiomas and 35 with untreated hepatic malignant neoplasms had FBDW and T2WFSE MR imaging. Hepatic lesions were characterized with ADC measurement and visual evaluation. Interobserver agreement for ADC measurement was calculated. Association between ADC value and lesion type was assessed using univariate analysis. Sensitivity, specificity and accuracy of ADC values and visual evaluation of MR images for the diagnosis of untreated malignant hepatic neoplasm were compared.

Results

ADC measurements showed excellent interobserver correlation (intraclass correlation coefficient = 0.980). Malignant neoplasms had lower ADC values than hemangiomas for the two observers (1.11 × 10⁻³ mm²/s ± .21 × 10⁻³vs. 1.77 × 10⁻³ mm²/s ± .29 × 10⁻³ for observer 1 and 1.11 × 10⁻³ mm²/s ± .19 × 10⁻³vs. 1.79 × 10⁻³ mm²/s ± .32 × 10⁻³ for observer 2) and univariate analysis found significant correlations between lesion type and ADC values. Depending on ADC threshold value, accuracy for the diagnosis of malignant neoplasm varied from 82.9% to 94.3%. Using visual evaluation, FBDW showed better specificity and accuracy than T2WFSE MR images for the diagnosis of malignant neoplasm (97.1% vs. 77.1% and 94.3% vs. 62.9%, respectively).

Conclusion

FBDW imaging provides reproducible quantitative information and surpasses the value of T2WFSE MR imaging for differentiating between cavernous hemangiomas and untreated malignant hepatic neoplasms.     

Effectiveness of regular proactive massage therapy for novice recreational runners

Objectives

To assess effects of a regular massage program on novice runners over a longer-term training period.

Participants

Twelve control and sixteen massage subjects took part in the study.

Setting

Both groups participated in 10-week running preparation clinics.

Design

An individualized massage treatment plan was developed for each massage group participant. Massage group subjects met weekly with a registered massage therapist for a half hour massage. Control subjects were given no massage treatments.

Main outcome measures

All participants maintained a running journal that recorded running behavior: frequency, distance, intensity, and pain. At weeks 1, 5, and 10, muscle strength, leg pain, daily functioning, and running confidence were assessed.

Results

The running behavior of both groups was similar (p > 0.05). Both groups experienced a considerable amount of pain when they ran. However, 100% of the massage group compared to 58.3% of control group completed the 10 km race.

Conclusions

A regular massage therapy program during training did not improve indices of muscle strength, pain perception, daily functioning or running confidence. However, the entire massage group met their targeted running goals while only half of the control was able to do so however this difference may not be attributable to the massage intervention.     

Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions

Objective

To evaluate the significance of contrast-enhanced ultrasound (CEUS) examination in differential diagnosis of malignant and benign breast lesions.

Methods

Seventy-one patients with seventy-six breast tumors are selected randomly. CEUS examinations were performed before and after bolus injection of the contrast agent SonoVue (Bracco, Milan, Italy). Specific sonographic quantification software, Qontrast, was adopted to determine the morphology of vessels. Wash-in and wash-out parameters of each lesion were assessed for both procedures.

Results

The final histopathological findings distinguished 45 malignant and 31 benign from all of the lesions. Following SonoVue administration different perfusion phases could be identified: early (0-1 min), mid (1-4 min) and late (4-6 min) phases. In the early phase, CEUS identified 91.1% of malignant tumors characterized by a claw-shaped enhancement, while 83.9% of benign tumors had a homogeneous enhancement, with a statistically significant difference between the two enhancement patterns (χ² = 43.16, P < 0.01). Moreover, contrast medium persistence in the late phase was helpful in the identification of benign and malignant tumors (χ² = 46.88, P < 0.01): contrast medium was present in 88.9% of malignant tumors, while in only 9.7% of the benign tumors. The study showed that various parametric imaging color maps for peak intensity and time to peak were mostly suggestive of malignancy, while quite uniform peak intensity and time to peak of color maps were the characteristic of benign tumors. The study also found that malignant lesions presented with a higher maximum intensity signal than benign ones (P < 0.05) on the time-intensity curves.

Conclusions

CEUS cooperating with conventional US shows improved accuracy in differentiating between malignant and benign breast tumors. It could be a reliable diagnostic method of breast lesions.     

Evaluation of stereotactic core biopsies of the breast with the 10-gauge Vacora® biopsy device: a review of 541 procedures

Purpose

To evaluate stereotactic core biopsies of the breast with the 10-gauge Vacora^® biopsy device.

Patients and methods

Retrospective study of 541 procedures in 502 patients performed between 2007 and 2009.

Results

The procedure failed in 2 % of cases, non-complicated hematomas occurred in 5 % of cases and unsightly scars in two cases. A clip was deployed in 70 % of cases, successfully in 99 % of cases. The procedure was well tolerated in 88 % of cases. Core biopsies confirmed a benign lesion in 55 % of cases, borderline lesions in 19 % of cases and malignant lesions in 26 % of cases with complementary surgery performed in 40 % of cases. For surgical lesions, sensitivity, specificity, PPV and NPV were 89 %, 100 %, 100 % and 84 % respectively. Atypical ductal dysplasia was under-estimated in 8 % of cases while DCIS was under-estimated in 14 % of cases. After review of the mammograms, 3 % of Bi-Rads 4 lesions were reclassified as Bi-Rads 3 lesions, all benign at core biopsy. Half of these results were from screening mammography programs.

Conclusion

Results with the 10-gauge Vacora^® biopsy device are similar to reports from the literature, mainly using the Mammotome system, with regards to tolerability and reliability for a lesser cost.     

Role of magnetic resonance diffusion-weighted imaging in evaluating response after chemoembolization of hepatocellular carcinoma

Objective

To investigate the value of hepatocellular carcinoma pretreatment apparent diffusion coefficients (ADCs) and its ADCs changes after treatment in predicting and early monitoring the response after chemoembolization.

Materials and methods

Twenty-five responding and nine nonresponding hepatocellular carcinoma lesions were prospectively evaluated with magnetic resonance diffusion-weighted imaging in 24 h before and in 48 h after chemoembolization. Quantitative ADC maps were calculated with images with b values of 0 and 500 s/mm².

Results

Nonresponding lesions had a significantly higher pretreatment mean ADC than did responding lesions (1.726 ± 0.323 × 10⁻³ mm²/s vs.1.294 ± 0.185 10⁻³ mm²/s, P ≤ 0.001). The results of receiver operator characteristic (ROC) analysis for identification of nonresponding lesions showed that threshold ADC value of 1.618 × 10⁻³ mm²/s had 96.0% sensitivity and 77.8% specificity. After transarterial chemoembolization, responding lesions had a significant increase in %ADC values than did nonresponding lesions (32.63% vs. 5.24%, P = 0.025). The results of ROC analysis for identification of responding lesions showed that threshold %ADC value of 16.21% had 72% sensitivity and 100% specificity. No significant change was observed in normal liver parenchyma (P = 0.862) and spleen (P = 0.052).

Conclusion

High pretreatment mean ADC value of hepatocellular carcinoma was predictive of poor response to chemoembolization. A significant increase in %ADC value was observed in lesions that responded to chemoembolization.     

Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes

Purpose

To evaluate echo-planar diffusion-weighted MR imaging (DWI) in the differentiation between benign and malignant cervical lymph nodes.

Materials and methods

35 consecutive patients with 55 enlarged (>10 mm) cervical lymph nodes underwent MR imaging at 1.5-T. DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values (b: diffusion factor) of 0, 500 and 1000 s/mm². Apparent diffusion coefficient (ADC) maps were reconstructed for all patients and ADC values were calculated for each lymph node. Imaging results were correlated with histopathologic findings after neck dissection or surgical biopsy, findings in PET/CT or imaging follow-up. Mann-Whitney test was used for statistical analysis and a receiver operating characteristic (ROC) curve analysis was performed.

Results

Cervical lymph node enlargement was secondary to metastases from squamous cell carcinomas [n = 25], non-Hodgkin’s lymphoma [n = 6], reactive lymphadenitis [n = 20], cat scratch lymphadenitis [n = 2] and sarcoidosis [n = 2]. The mean ADC values (×10⁻³ mm²/s) were 0.78 ± 0.09 for metastatic lymph nodes, 0.64 ± 0.09 for lymphomatous nodes and 1.24 ± 0.16 for benign cervical lymph nodes. ADC values of malignant lymph nodes were significantly lower than ADC values of benign lymph nodes. 94.3% of lesions were correctly classified as benign or malignant using a threshold ADC value of 1.02 × 10⁻³ mm²/s.

Conclusion

According to our first experience, DWI using a SSEPI sequence allows reliable differentiation between benign and malignant cervical lymph nodes.     

Diagnosis and quantification of hepatic fibrosis in children with diffusion weighted MR imaging

Purpose

To evaluate the accuracy of diffusion weighted MR imaging in diagnosis and quantification of hepatic fibrosis in children with chronic hepatitis.

Materials and methods

Sixty-three consecutive children (40 boys, 23 girls, median age 9.3 years), with chronic hepatitis and thirty age matched volunteers underwent diffusion weighted MR imaging of the liver using a single shot echoplanar imaging with b-value = 0, 250, and 500 s/mm². Liver biopsy was obtained with calculation of METAVIR score. The ADC value of the liver was correlated with METAVIR score. Receiver operating characteristic curve was done for diagnosis and grading of hepatic fibrosis.

Results

There was statistical difference in the mean ADC value between volunteers and patients with hepatic fibrosis (P = 0.001) and in patients with different grades of METAVIR scores (P = 0.002). There was correlation between the mean ADC value and METAVIR score (r = 0.807, P = 0.001). The cut off point to predict fibrosis (1.7 × 10⁻³ mm²/s) revealed 83% accuracy, 85% sensitivity, 82% specificity, 83% PPV, and 85% NPV. The area under the curve was 0.91 for F1, 0.85 for F2, 0.86 for F3 and 0.90 for F4.

Conclusion

The apparent diffusion coefficient value is a promising quantitative parameter used for diagnosis and quantification of hepatic fibrosis in children with chronic hepatitis.     

Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance

Purpose

To determine whether prospective electrocardiogram (ECG)-gated delayed contrast-enhanced dual-source computed tomography (DCE-DSCT) can accurately delineate the extension of myocardial infarction (MI) compared with delayed enhanced cardiac MR (DE-MR).

Material and methods

Eleven patients were examined using dual-source CT and cardiac MR in 2 weeks after a first reperfused MI. DCE-DSCT scan protocol was performed with prospective ECG-gating sequential scan model 7 min after contrast administration. In a 17-model, infarcted myocardium detected by DE-MR was categorized as transmural and subendocardial extension. Segment of infarcted location and graded transmurality were compared between DCE-MDCT and DE-MR.

Results

In all eleven patients, diagnostic quality was obtained for depicting delayed enhanced myocardium. Agreement between DCE-DSCT and MR was good on myocardial segment based comparison (kappa = 0.85, p < 0.001), and on transmural and subendocardial infarction type comparison (kappa = 0.82, p < 0.001, kappa = 0.52, p < 0.001, respectively). CT value was higher on infarcted region than that of normal region (100.02 ± 9.57 HU vs. 72.63 ± 7.32 HU, p < 0.001). Radiation dose of prospectively ECG-gating protocol were 0.99 ± 0.08 mSv (0.82-1.19 mSv).

Conclusions

Prospective ECG-gated DCE-DSCT can accurately assess the extension and the patterns of myocardial infarction with low radiation dose.     

The utility of diffusion-weighted MR imaging in differentiation of uterine adenomyosis and leiomyoma

Purpose

To investigate the value of diffusion-weighted MR imaging (DWI), especially apparent diffusion coefficient (ADC) in the differentiation of uterine adenomyosis and leiomyoma.

Materials and methods

17 patients with uterine leiomyoma and 22 patients with uterine adenomyosis underwent diffusion-weighted imaging (DWI) in addition to routine MR imaging. The ADC values, as well as ADC D-value (defined as the ADC value of high signal intensive foci minus the ADC value of lesion tissues the difference in value), were measured and compared to investigate whether they could help in the differentiation of uterine adenomyosis and leiomyoma. Histopathologic examination was conducted as the golden standard.

Results

For high signal intensive foci within the lesions, uterine adenomyosis demonstrated significantly lower mean ADC value than uterine leiomyoma (1.582 vs. 2.122 × 10⁻³ mm²/s, P = 0.001). For lesion tissues, uterine adenomyosis demonstrated significantly higher mean ADC value than uterine leiomyoma (1.214 vs. 0.967 × 10⁻³ mm²/s, P = 0.001). However, there was overlap between uterine adenomyosis and leiomyoma in both measurements. Mean ADC D-value was significantly lower in uterine adenomyosis than in uterine leiomyoma (0.369 vs. 1.096 × 10⁻³ mm²/s, P = 0.000). ADC D-value had no overlap between uterine adenomyosis and leiomyoma.

Conclusion

DWI can be applied for the further differentiation of uterine adenomyosis and leiomyoma, in addition to routine MR imaging. ADC D-value may be a more useful tool than ADC value in the differentiation.     

Previous imaging findings of breast cancers that occurred in combined screening negatives

Purpose

To retrospectively evaluate previous imaging findings of breast cancers that occurred in women whose combined screening using both mammography and ultrasonography was negative.

Materials and methods

A search of the institutional database identified 65 patients with breast cancers who had comparable previous negative screening mammography and ultrasonography (BI-RADS category 1 or 2) within 2 years. We classified each case as true or false negative. The previous imaging findings and the final outcome were analyzed.

Results

Among 65 cases, 42 (65%) were true negatives, 23 (35%) were false negatives. The abnormalities of false negatives were underestimated in 16 (70%) and unrecognized in 7 (30%). The findings were calcifications (n = 8) or a mass (n = 6) on mammography, a mass (n = 5) or a non-mass (n = 3) on ultrasonography and a density on mammography correlated with non-mass on ultrasonography (n = 1). Ductal carcinoma in situ among false and true negatives accounted for 5 (22%) and 7 (17%), respectively. Symptomatic cancers among false and true negatives were 6 (26%) and 13 (31%), respectively.

Conclusion

Breast cancers that rarely occurred in combined screening negatives are often retrospectively seen as minimal abnormalities on previous imaging studies.