Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study.

Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes.

Methods: The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis.

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA).

Objectives: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue.

Methods: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers.

Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study.

Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not.

Results of Short-Term Follow-Up in BI-RADS 3 and 4a Breast Lesions with a Histological Diagnosis of Fibroadenoma at Percutaneous Needle Biopsy.

Objective: To evaluate the usefulness of short-term (6 months) follow-up in patients with Breast Imaging Report and Data System (BI-RADS) 3 and 4a lesions, after a diagnosis of fibroadenoma at an image-guided biopsy.

Patients And Methods: The data of 318 women with 349 biopsy-proven fibroadenomas, a 6-month follow-up, and a follow-up of ≥ 24 months were retrospectively reviewed. Information on clinical history, lesion characteristics on ultrasound (US), mammography, and magnetic resonance imaging (MRI), BI-RADS classification, and follow-up was collected.

Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging.

Objectives: To evaluate the agreement between automated breast volume scanner (ABVS) and conventional ultrasound (US) as a second-look (SL) tool for assessing additional findings found on MRI.

Methods: Over a 7-month period, we prospectively assigned to SL-US and SL-ABVS all patients undergoing 1.5 T breast MRI in whom additional findings were found.

Foci on breast magnetic resonance imaging in high-risk women: cancer or not?

Purpose: To assess how frequently foci are identified on MRI in high-risk patients, and their association with malignancy, breast density, and background parenchymal enhancement (BPE).

Materials And Methods: In this multicentric study, two readers, in consensus, retrospectively reviewed screening breast MRI of 245 high-risk women, performed between 2009 and 2014. Eligible patients had at least two consecutive screening MRI, and a follow-up of at least 1 year after a lesion was first detected; histology was available for all suspicious findings.

Liver involvement by multiple myeloma presenting as hypervascular focal lesions in a patient with chronic hepatitis B infection.

Extramedullary myeloma refers to the infiltration of neoplastic monoclonal plasma cells in either organs or soft tissues. The disease is clinically and radiologically underestimated compared with the autopsy findings and is usually associated with a more aggressive clinical course and poorer outcome. A minority of patients with extramedullary myeloma show hepatic involvement, usually in the form of diffuse parenchymal infiltration.

Impact on the recall rate of digital breast tomosynthesis as an adjunct to digital mammography in the screening setting. A double reading experience and review of the literature.

Objectives: To estimate the impact on recall rate (RR) of digital breast tomosynthesis (DBT) associated with digital mammography (DM+DBT), compared to DM alone, evaluate the impact of double reading (DR) and review the literature.

Methods: Ethics committees approved this multicenter study. Patients gave informed consent.

Impact of multiparametric magnetic resonance imaging on risk group assessment of patients with prostate cancer addressed to external beam radiation therapy.

Purpose: To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on risk group assessment of patients with prostate cancer (PCa) initially addressed to external beam radiation therapy (EBRT).

Materials And Methods: We prospectively performed mpMRI (3.0Tsystem) in 44 patients addressed to EBRT, using a multiparametric protocol (high-resolution multiplanar T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging).

Management of atypical lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ.

Atypical hyperplasia and lobular carcinoma in situ are rare proliferative breast lesions, growing inside ducts and terminal ducto-lobular units. They represent a marker of increased risk for breast cancer and a non-obligate precursor of malignancy. Evidence available on diagnosis and management is scarce.

Is there a systematic bias of apparent diffusion coefficient (ADC) measurements of the breast if measured on different workstations? An inter- and intra-reader agreement study.

Objectives: To evaluate the influence of post-processing systems, intra- and inter-reader agreement on the variability of apparent diffusion coefficient (ADC) measurements in breast lesions.

Methods: Forty-one patients with 41 biopsy-proven breast lesions gave their informed consent and were included in this prospective IRB-approved study. Magnetic resonance imaging (MRI) examinations were performed at 1.

Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis.

Objectives: To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US).

Methods: We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5.

MR mammography using diffusion-weighted imaging in evaluating breast cancer: a correlation with proliferation index.

Purpose: To evaluate whether the variation of the apparent diffusion coefficient (ADC) values obtained with DWI can predict elevated levels of Ki67 proliferation index and aggressive subtypes in patients with breast cancer.

Materials And Methods: Breast MRI studies of 115 patients (mean age 57.3 years, range 36-81 years) with a biopsy-proven breast cancers were evaluated in this retrospective IRB-approved study.

Test-retest reliability of diffusion tensor imaging of the liver at 3.0 T.

Purpose: This study was done to evaluate test-retest reliability of liver diffusion tensor imaging (LDTI).

Materials And Methods: Ten healthy volunteers (median age 23 years) underwent two LDTI scans on a 3.0 T magnet during two imaging sessions separated by 2 weeks (session-1/-2, respectively).

Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT.

Despite advances in patient and graft management, biliary complications (BC) still represent a challenge both in the early and delayed period after orthotopic liver transplantation (OLT). Because of unspecific clinical presentation, imaging is often mandatory in order to diagnose BC. Among imaging modalities, magnetic resonance cholangiography (MRC) has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively, using both the conventional technique (based on heavily T2-weighted sequences) and contrast-enhanced MRC (based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents).

Post-operative imaging in liver transplantation: state-of-the-art and future perspectives.

Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT.

Differentiating small (≤1 cm) focal liver lesions as metastases or cysts by means of computed tomography: a case-study to illustrate a fuzzy logic-based method to assess the impact of diagnostic confidence on radiological diagnosis.

Purpose: To quantify the impact of diagnostic confidence on radiological diagnosis with a fuzzy logic-based method.

Materials And Methods: Twenty-two oncologic patients with 20 cysts and 30 metastases ≤1 cm in size found at 64-row computed tomography were included. Two readers (R1/R2) expressed diagnoses as a subjective level of confidence P(d) in malignancy within the interval [0,1] rather than on a "crisp" basis (malignant/benign); confidence in benignancy was 1 - p(d).

Does diffusion-weighted imaging add diagnostic confidence in discriminating between benign and malignant solid focal liver lesions?

We investigated whether diffusion-weighted Imaging (DWI) adds diagnostic confidence in assessing focal liver lesions (FLLs). By reviewing FLLs without and with DWI at 1.5 T, two radiologists scored the confidence in diagnosing benignancy/malignancy (confidence score), and DWI usefulness (usefulness score).

Role of magnetic resonance imaging in probably benign (BI-RADS category 3) microcalcifications of the breast.

Purpose: This study was undertaken to evaluate whether magnetic resonance (MR) imaging is able to rule out malignancy in the case of BI-RADS 3 microcalcifications, providing a sufficient negative predictive value (NPV) for early work-up, and to reduce unnecessary stereotactically guided vacuum-assisted biopsy (SVAB) procedures.

Materials And Methods: We prospectively enrolled consecutive women with BI-RADS 3 microcalcifications, who subsequently underwent MR imaging and SVAB. The MR studies were reviewed according to the MR-BI-RADS classification system; lesions assessed as MR-BI-RADS 1 and 2 were considered negative for malignancy, categories MR-BI-RADS 3, 4 and 5 indicated malignant lesions.

Comparison between different imaging techniques in the evaluation of malignant breast lesions: can 3D ultrasound be useful?

Purpose: This study was done to assess the feasibility of three-dimensional ultrasonography (3D-US) for volume calculation of solid breast lesions.

Materials And Methods: The volumes of 36 malignant lesions were measured using conventional 2D-US, 3D-US and magnetic resonance imaging (MRI) and compared with that obtained with histology (standard of reference). With 2D Ultrasouns, volume was estimated by measuring three diameters and calculating volume with the mathematical formula for spheres.