Continuity of Radiologists Between Diagnostic Breast Imaging and Image-Guided Breast Biopsy: Impact on Patient-Reported Biopsy Morbidity Experiences.

Objective: To determine whether continuity of care between diagnostic breast imaging and subsequent image-guided breast biopsy could reduce patient-reported biopsy-related morbidity.

Methods: This was a prospective, pragmatically randomized, 2-arm health utilities analysis of 200 women undergoing diagnostic breast imaging followed by US- or stereotactic-guided breast biopsy at a single quaternary care center from September 3, 2019, to April 10, 2023. Breast biopsy-naive women with a BI-RADS 4 or 5 finding at diagnostic imaging were randomly scheduled for the typically first available biopsy appointment.

Atrial Fibrillation after Descending Aorta Repair: Occurrence, Risk Factors, and Impact on Outcomes.

Background:  As risks of repairing the descending thoracic and thoracoabdominal aorta diminish, common complications that may prolong hospital stay, or actually increase risk, require attention. One such complication is postoperative atrial fibrillation (AF). Therefore, we characterized prevalence of, risk factors for, and effects of postoperative atrial fibrillation (PoAF) after descending and thoracoabdominal aorta repair.

Prospective multicenter assessment of patient preferences for properties of gadolinium-based contrast media and their potential socioeconomic impact in a screening breast MRI setting.

Objective: It is unknown how patients prioritize gadolinium-based contrast media (GBCM) benefits (detection sensitivity) and risks (reactions, gadolinium retention, cost). The purpose of this study is to measure preferences for properties of GBCM in women at intermediate or high risk of breast cancer undergoing annual screening MRI.

Methods: An institutional reviewed board-approved prospective discrete choice conjoint survey was administered to patients at intermediate or high risk for breast cancer undergoing screening MRI at 4 institutions (July 2018-March 2020).

Annual Screening Mammography Associated With Lower Stage Breast Cancer Compared With Biennial Screening.

The purpose of this study was to compare breast cancer characteristics and treatment regimens among women undergoing annual versus nonannual screening mammography. In this retrospective, institutional review board-approved, HIPAA-compliant cohort study, a breast cancer database was queried for patients who received a mammographic or clinical diagnosis of breast cancer during 2016-2017. Annual versus biennial and annual versus nonannual (biennial and triennial) mammography screening cohorts were compared using tests or Wilcoxon rank sum tests for continuous variables and chi-square or Fisher exact tests for categoric variables.

Digital Mammography Has Persistently Increased High-Grade and Overall DCIS Detection Without Altering Upgrade Rate.

The purpose of this article is to evaluate whether digital mammography (DM) is associated with persistent increased detection of ductal carcinoma in situ (DCIS) or has altered the upgrade rate of DCIS to invasive cancer. An institutional review board-approved retrospective search identified DCIS diagnosed in women with mammographic calcifications between 2001 and 2014. Ipsilateral cancer within 2 years, masses, papillary DCIS, and patients with outside imaging were excluded, yielding 484 cases.

Digital Breast Tomosynthesis Slab Thickness: Impact on Reader Performance and Interpretation Time.

Background Digital breast tomosynthesis (DBT) helps reduce recall rates and improve cancer detection compared with two-dimensional (2D) mammography but has a longer interpretation time. Purpose To evaluate the effect of DBT slab thickness and overlap on reader performance and interpretation time in the absence of 1-mm slices. Materials and Methods In this retrospective HIPAA-compliant multireader study of DBT examinations performed between August 2013 and July 2017, four fellowship-trained breast imaging radiologists blinded to final histologic findings interpreted DBT examinations by using a standard protocol (10-mm slabs with 5-mm overlap, 1-mm slices, synthetic 2D mammogram) and an experimental protocol (6-mm slabs with 3-mm overlap, synthetic 2D mammogram) with a crossover design.

Prospective Imaging Trial Assessing Gadoteridol Retention in the Deep Brain Nuclei of Women Undergoing Breast MRI.

Rationale And Objectives: To assess for indirect evidence of gadoteridol retention in the deep brain nuclei of women undergoing serial screening breast MRI.

Methods: This HIPAA-compliant prospective observational noninferiority imaging trial was approved by the IRB. From December 2016 to March 2018, 12 consented subjects previously exposed to 0-1 doses of gadoteridol (group 1) and 7 consented subjects previously exposed to ≥4 doses of gadoteridol (group 2) prospectively underwent research-specific unenhanced brain MRI including T1w spin echo imaging and T1 mapping.

Architectural distortion in the era of digital breast tomosynthesis: outcomes and implications for management.

Purpose: Digital breast tomosynthesis (DBT) has been shown to increase conspicuity of some mammographic findings, particularly architectural distortion (AD). The purpose of this retrospective study was to determine the positive predictive value of AD on diagnostic DBT, and evaluate associations between AD characteristics and histopathologic outcomes.

Methods: This IRB-approved, HIPAA-compliant study included diagnostic DBT exams performed between 1/2014 and 12/2015 that demonstrated AD.

PET/MRI in Breast Cancer.

Positron emission tomography / magnetic resonance imaging (PET/MRI) is an emerging imaging technology that allows for the acquisition of multiple MRI parameters simultaneously with PET data. In this review, we address the technical requirements of PET/MRI including protocols and tracers, the potential of integrated localized breast PET/MRI exams, and possible applications of whole-body PET/MRI in breast cancer patients. Currently, PET/MRI can be performed on sequential and integrated PET/MRI scanners but, as not all practices can access these dedicated machines, several studies look at PET and MRI exams that are performed separately on separate scanners within a short time frame.

Comparison between qualitative and quantitative assessment of background parenchymal enhancement on breast MRI.

Background: Potential clinical implications of the level of background parenchymal enhancement (BPE) on breast MRI are increasing. Currently, BPE is typically evaluated subjectively. Tests of concordance between subjective BPE assessment and computer-assisted quantified BPE have not been reported.

Clinical applicability and relevance of fibroglandular tissue segmentation on routine T1 weighted breast MRI.

Purpose: To evaluate clinical applicability of fibroglandular tissue (FGT) segmentation on routine T1 weighted breast MRI and compare FGT quantification with radiologist assessment.

Methods: FGT was segmented on 232 breasts and quantified, and was assessed qualitatively by four breast imagers.

Results: FGT segmentation was successful in all 232 breasts.

Voxelwise analysis of simultaneously acquired and spatially correlated F-fluorodeoxyglucose (FDG)-PET and intravoxel incoherent motion metrics in breast cancer.

Purpose: Diffusion-weighted imaging (DWI) and F-fluorodeoxyglucose-positron emission tomography ( F-FDG-PET) independently correlate with malignancy in breast cancer, but the relationship between their structural and metabolic metrics is not completely understood. This study spatially correlates diffusion, perfusion, and glucose avidity in breast cancer with simultaneous PET/MR imaging and compares correlations with clinical prognostics.

Methods: In this Health Insurance Portability and Accountability Act-compliant prospective study, with written informed consent and approval of the institutional review board and using simultaneously acquired FDG-PET and DWI, tissue diffusion (D ), and perfusion fraction (f ) from intravoxel incoherent motion (IVIM) analysis were registered to FDG-PET within 14 locally advanced breast cancers.

Background parenchymal enhancement over exam time in patients with and without breast cancer.

Purpose: To compare background parenchymal enhancement (BPE) over time in patients with and without breast cancer.

Materials And Methods: This retrospective Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study included 116 women (25-84 years, mean 54 years) with breast cancer who underwent breast magnetic resonance imaging at 3T between 1/2/2009 and 12/29/2009 and 116 age and date-of-exam-matched women without breast cancer (23-84 years, mean 51 years). Two independent, blinded readers (R1, R2) recorded BPE (minimal, mild, moderate, marked) at three times (100, 210, and 320 seconds postcontrast).

Use of a Quality Improvement Initiative to Achieve Consistent Reporting of Level of Suspicion for Tumor on Multiparametric Prostate MRI.

Objective: The purpose of this article is to evaluate the utility of a quality improvement (QI) initiative in achieving long-term adherence to an evolving structured format for reporting the level of suspicion for tumor on prostate MRI examinations.

Materials And Methods: The original QI initiative occurred over a 4-month period in 2010, before which prostate MRI was reported using free text. The initiative consisted of development of a section-wide macro, an initial group training session, ordering physician input regarding the structured report's value, subsequent weekly sessions for ongoing review, and timely individualized feedback in instances of nonuse.

Comparison of Whole-Body (18)F FDG PET/MR Imaging and Whole-Body (18)F FDG PET/CT in Terms of Lesion Detection and Radiation Dose in Patients with Breast Cancer.

Purpose To compare fluorine 18 ((18)F) fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and magnetic resonance (MR) imaging with (18)F FDG combined PET and computed tomography (CT) in terms of organ-specific metastatic lesion detection and radiation dose in patients with breast cancer. Materials and Methods From July 2012 to October 2013, this institutional review board-approved HIPAA-compliant prospective study included 51 patients with breast cancer (50 women; mean age, 56 years; range, 32-76 years; one man; aged 70 years) who completed PET/MR imaging with diffusion-weighted and contrast material-enhanced sequences after unenhanced PET/CT. Written informed consent for study participation was obtained.

Standardized Uptake Values from PET/MRI in Metastatic Breast Cancer: An Organ-based Comparison With PET/CT.

Quantitative standardized uptake values (SUVs) from fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are commonly used to evaluate the extent of disease and response to treatment in breast cancer patients. Recently, PET/magnetic resonance imaging (MRI) has been shown to qualitatively detect metastases from various primary cancers with similar sensitivity to PET/CT. However, quantitative validation of PET/MRI requires assessing the reliability of SUVs from MR attenuation correction (MRAC) relative to CT attenuation correction (CTAC).

Perioperative heart-type fatty acid binding protein levels in atrial fibrillation after cardiac surgery.

Background: Postoperative atrial fibrillation (POAF) is common and associated with poor outcomes. Perioperative ischemia can alter arrhythmic substrate.

Objective: To demonstrate an association between perioperative measurements of heart-type fatty acid binding protein (HT-FABP), a sensitive marker of ischemic myocardial injury.

Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management.

Objective: Controversy surrounds the treatment of chronic aortic dissection. Open surgical and endovascular experiences include mixed populations treated with evolving strategies and limited follow-up. We establish a standard against which endovascular repair can be compared by assessing outcomes after open repair of chronic distal aortic dissections anatomically suitable to stent-grafting.

Distal landing zone open fenestration facilitates endovascular elephant trunk completion and false lumen thrombosis.

Background: Controversy surrounds the endovascular treatment of chronic dissection because of inconsistent remodeling of the aorta. The purpose of this study was to assess efficacy and safety of a novel technique for repairing aneurysmal change associated with chronic descending aortic dissection.

Methods: From July 2007 to April 2011, 24 patients with descending aortic aneurysmal change, consequent to previously repaired ascending aortic dissection or medically treated descending dissection, underwent combined open first-stage elephant trunk (ET) insertion and fenestration of the descending aorta intimal flap.

Modified and "reverse" frozen elephant trunk repairs for extensive disease and complications after stent grafting.

Background: The frozen elephant trunk (FET) repair technique combines conventional arch repair with the patient under circulatory arrest with stent grafting and is increasingly being used to treat extensive thoracic aortic disease. This surgical approach is evolving, including its use for complications after thoracic aortic stent grafting - the so-called reversed frozen elephant trunk (RFET). We evaluated the safety and efficacy of FET and RFET operations in high-risk patients.

Hypocomplementemic urticarial vasculitis syndrome: a rare cause of basilar panacinar emphysema.

Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare condition characterized by an immune complex-mediated disruption of multiple organ systems. Pulmonary involvement is a major cause of morbidity and mortality in patients with HUVS. HUVS has been described by clinical, histological, and laboratory findings.

Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications.

Introduction: Patients with chronic distal aortic dissection (CDAD) remain at high risk for late aorta-related events and reinterventions, and the ideal management strategy remains undefined. Open surgical procedures carry morbidity, but scant data for thoracic endovascular aortic repair (TEVAR) of CDAD exist. This study reports our intermediate-term results with TEVAR for complicated CDAD.

Acceptance and durability of surveillance as a management choice in men with screen-detected, low-risk prostate cancer: improved outcomes with stringent enrollment criteria.

Objective: To analyze the acceptance rate and durability of surveillance among contemporary men with low-risk prostate cancer managed at a large, US academic institution.

Methods: Patients with low-risk parameters on initial and repeat biopsy were offered surveillance regardless of age. Regular clinical evaluation and repeat prostate biopsy were recommended every 1-2 years, and intervention was recommended based on adverse clinical and pathologic parameters on follow-up.

Operational tolerance to class I disparate lungs can be induced despite pretransplant immunization with class I allopeptides.

Background: Using a class I-disparate swine lung transplant model, we examined whether an intensive course of tacrolimus could induce operational tolerance and whether preoperative allopeptide immunization would prevent the development of tolerance.

Methods: Left lung grafts were performed using class I-disparate (class II-matched) donors. Recipients were treated with 12 days of postoperative tacrolimus.