MATERIALS AND METHODS. MRI of the urethra was performed in 84 women with lower urinary tract symptoms using multiplanar T2-weighted turbo spin-echo and unenhanced and contrast-enhanced gradient-echo sequences. A dynamic true fast imaging with steady-state free precession sequence was performed during straining in the sagittal plane. Images were evaluated by two radiologists for urethral pathology and pelvic organ prolapse. MRI findings were correlated with clinical symptoms using the Fisher's exact and Mann-Whitney tests.

RESULTS. Urethral abnormalities were found in 10 of 84 patients (11.9%), including two urethral diverticula, five Skene's gland cysts or abscesses, and three periurethral cysts. Thirty-three patients (39.3%) were diagnosed with pelvic organ prolapse, of whom 29 (87.9%) were diagnosed exclusively on dynamic imaging. In 29 of 33 patients with prolapse (87.9%), the urethra was structurally normal. MRI showed 13 cystoceles and 17 cases of urethral hypermobility not detected on physical examination. Patients with a greater number of vaginal deliveries, stress urinary incontinence, frequency of voiding, and voiding difficulty were statistically more likely to have anterior compartment prolapse (p < 0.05).

CONCLUSION. Including a dynamic sequence permits both structural and functional evaluation of the urethra, which may be of added value in women with lower urinary tract symptoms. Dynamic MRI allows detection of pelvic organ prolapse that may not be evident on conventional static sequences.

MATERIALS AND METHODS. The retrospective study included 70 women with 83 suspicious breast lesions on DCE-MRI (BI-RADS 4 or 5) who underwent subsequent biopsy. DWI was acquired during clinical breast MRI using b = 0 and 600 s/mm². Apparent diffusion coefficient (ADC) values were compared for benign and malignant lesions. PPV was calculated for DCE-MRI alone (based on biopsy recommendations) and DCE-MRI plus DWI (adding an ADC threshold) for the same set of lesions. Results were further compared by lesion type (mass, nonmasslike enhancement) and size.

RESULTS. Of the 83 suspicious lesions, 52 were benign and 31 were malignant (11 ductal carcinoma in situ [DCIS], 20 invasive carcinoma). Both DCIS (mean ADC, 1.31 ± 0.24 x 10^–3 mm²/s) and invasive carcinoma (mean ADC, 1.29 ± 0.29 x 10^–3 mm²/s) exhibited lower mean ADC than benign lesions (1.70 ± 0.44 x 10^–3 mm²/s, p < 0.001). Applying an ADC threshold of 1.81 x 10^–3 mm²/s for 100% sensitivity produced a PPV of 47% versus 37% for DCE-MRI alone, which would have avoided biopsy for 33% (17/52) of benign lesions without missing any cancers. DWI increased PPV similarly for masses and nonmasslike enhancement and preferentially improved PPV for smaller (≤ 1 cm) versus larger lesions.

CONCLUSION. DWI shows potential for improving the PPV of breast MRI for lesions of varied types and sizes. However, considerable overlap in ADC of benign and malignant lesions necessitates validation of these findings in larger studies.

MATERIALS AND METHODS. The cases of all women with round, oval, or lobular palpable masses with circumscribed margins and homogeneous ultrasound echotexture for which short-term follow-up was recommended from July 1997 through December 2003 were retrospectively identified. Evaluation was by ultrasound and/or mammography and focused clinical examination. Outcome was assessed with imaging or clinical follow-up lasting at least 12 months. The cancer incidence for palpable lesions was compared with that for nonpalpable lesions recommended for short-term follow-up.

RESULTS. In 379 women, 443 palpable masses with benign features for which short-term follow-up was recommended were identified. Outcome data were available on 375 masses in 320 women. Lesions were evaluated with mammography and ultrasound (n = 186) or ultrasound alone (n = 189). Masses were typically identified only with ultrasound (n = 258, 68.8%); were oval (n = 275, 73.3%), of equal density to normal breast tissue on mammograms (n = 95 on 117 mammograms, 81.2%), and hypoechoic (n = 336 in 372 ultrasound examinations, 90.3%); and were prospectively believed to be fibroadenoma (n = 304, 81.1%). Eighty-five lesions (22.7%) were biopsied soon after evaluation, and one 1.5-mm ductal carcinoma in situ was diagnosed. At follow-up (mean, 2.7 years), 26 lesions (6.9%) had grown. Twenty-four of the 26 lesions were biopsied, and no cancer was diagnosed. The overall cancer prevalence was similar for palpable (0.3%) and nonpalpable (1.6%) masses. The cost of short-term follow-up was less than that of biopsy.

CONCLUSION. Short-term follow-up is a reasonable alternative to biopsy of palpable breast lesions with benign imaging features, particularly for young women with probable fibroadenoma.

SUBJECTS AND METHODS. Between June 2006 and December 2006, preoperative axillary sonography was performed in 191 consecutive breast cancer patients (median age, 46 years; age range, 24–79 years) who had been scheduled to undergo breast cancer surgery with sentinel node biopsy. The axillary lymph node that had the thickest cortex or that was closest to the primary tumor was prospectively classified and then removed through sonographically guided needle localization. Correspondence about and histologic results for the needle-localized nodes and the radioactive sentinel nodes were analyzed. The rate of malignancy, according to the sonographic classification, and the area under a receiver operating characteristic curve were analyzed.

RESULTS. Of the 191 needle-localized nodes, 41 (21%) had metastases and 150 (79%) did not have metastases. When a cutoff point of a cortical thickness of 2.5 mm was used, sonographic classification showed 85% (35/41) sensitivity, 78% (117/150) specificity, and an area under the curve of 0.861 (95% CI, 0.796–0.926). Of the 54 patients with metastases at sentinel node biopsy or axillary lymph node dissection, 13 (24%) had false-negative results of sonographically guided needle localization. Unsuccessful lymphatic mapping because of absent radiotracer uptake during sentinel node biopsy was found in 4% (7/191), whereas all needle-localized nodes with a cortical thickness of more than 2.5 mm were confirmed as metastases.

CONCLUSION. Sonographic classification of axillary lymph nodes is effective for predicting the presence of metastases to avoid sentinel node biopsy or to reduce unsuccessful lymphatic mapping during sentinel node biopsy.

CONCLUSION. Serum progesterone concentrations corresponding to the follicular phase of a normal menstrual cycle can aid in optimal scheduling of breast MRI examinations for premenopausal women who lack cyclical menses.

CONCLUSION. Compared with 2D FRFSE, 3D FRFSE cube provides superior image quality and improved 3D reconstructions in a shorter acquisition time and enables excellent visualization of uterine anatomy in any orientation, regardless of the original scanning plane.

CONCLUSION. Sampling was successful in 15 of 18 cases. Errors occurred only in superficial lesions biopsied via the vertical approach. The halfpipe coaxial cannula shows promise for improving positioning accuracy, avoiding target dislocation, and obviating repeated needle repositioning.

MATERIALS AND METHODS. For this study, 410 patients who underwent biopsy of a breast lesion were included: fine-needle aspiration biopsy, n = 95 patients; core biopsy, n = 84; local excision under local anesthesia, n = 72; vacuum-assisted breast biopsy, n = 100; and hookwire localization, n = 59. Information about patient age, place of residence, whether complications occurred, and type of lesion was collected.

RESULTS. Compliance was higher among women who had undergone vacuum-assisted breast biopsy than those who had undergone one of the other biopsy methods. The superiority (carryover effect) of vacuum-assisted breast biopsy persisted for 18 months after the biopsy procedure. Patient compliance for all of the other biopsy methods followed an M pattern, with the peaks corresponding to the follow-up mammography sessions. In patients who had undergone vacuum-assisted breast biopsy, a gradual decrease in compliance over time was observed. Older women were more compliant than younger women with follow-up recommendations regardless of biopsy method. A subanalysis of the vacuum-assisted breast biopsy group indicated that complications are associated with better compliance.

CONCLUSION. Women more often adhere to clinical recommendations for follow-up sessions comprising mammography. Patient age and whether biopsy complications occurred also seem to modify compliance. Further studies should assess whether superior compliance after vacuum-assisted breast biopsy persists in other settings, such as with stereotactic or ultrasound guidance, different numbers of cores, and procedures of various durations.

CONCLUSION. Overall, TR-MRA is a useful sequence for the assessment of ovarian vein reflux, which may aid the evaluation of pelvic congestion syndrome.

MATERIALS AND METHODS. We retrospectively reviewed images from 115 MRI examinations of the breast performed from 1999 to 2005 for the indication of problem-solving for inconclusive findings on a mammogram. Forty-eight of the 115 women (41.8%) were at high risk. We discerned whether sonography or MRI was used as an adjunctive tool and correlated the findings with those in the pathology database.

RESULTS. The equivocal findings most frequently leading to MRI were asymmetry and architectural distortion. No suspicious MRI correlate was found in 100 of 115 cases (87%). These cases were found stable at follow-up mammography or MRI after a mean of 34 months. Fifteen enhancing masses (13%) that corresponded to the mammographic abnormality were seen on MR images. All masses identified at MRI were accurately localized for biopsy, and six malignant lesions were identified. Four of six malignant tumors were seen in one mammographic view only; two were seen on second-look ultrasound images. MRI had a sensitivity of 100% and compared with mammography had significantly higher specificity (91.7% vs 80.7%, p = 0.029), positive predictive value (40% vs 8.7%, p = 0.032), and overall accuracy (92.2% vs 78.3%, p = 0.0052). Eighteen incidental lesions (15.7%) were detected at MRI, and all were subsequently found benign.

CONCLUSION. We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images.

MATERIALS AND METHODS. We reviewed 1,523 consecutive breast MRI examinations performed from January 1, 2003, to June 30, 2005, to identify all lesions initially detected on MRI and assessed as BI-RADS 4 or 5 for which the patient underwent subsequent imaging-guided needle or excisional biopsy. BI-RADS lesion features were recorded for each case, and the risk of malignancy was assessed using generalized estimating equations. Separate multivariate models were constructed for lesions classified as masses.

RESULTS. Included in the analysis were 258 suspicious lesions in 196 women. Among all lesions, those of 1 cm or greater were significantly more often malignant (50/147, 34%) than lesions of less than 1 cm (22/111, 20%; odds ratio, 2.09; 95% CI, 1.13–3.83). For masses, size, BI-RADS margin, and enhancement pattern predicted malignancy. In multivariate analysis of combinations of features, masses of 1 cm or greater with heterogeneous enhancement and irregular margins had a 68% probability of malignancy. Masses of 1 cm or greater with smooth margins and homogeneous enhancement had the lowest predicted probability of malignancy of 3%. BI-RADS descriptors and size were not significant predictors of malignancy for nonmasslike enhancement (NMLE).

CONCLUSION. Combinations of BI-RADS lesion descriptors can predict the probability of malignancy for breast MRI masses but not for NMLE. If our model is validated, masses with a low probability of malignancy may be eligible for short-interval follow-up rather than biopsy. Further research focused on predictive features of NMLE is needed.

SUBJECTS AND METHODS. This prospective randomized study included patients with breast cancer scheduled for conservative tumor excision and sentinel node biopsy. Patients were randomized to either radioguided localization or wire localization. Comparative radiologic, surgical, and pathologic data were collected and analyzed to establish the duration, ease of use, and accuracy of the two techniques for occult lesion localization. The effectiveness of sentinel node biopsy also was assessed. One radiologist and two surgeons participated in the study.

RESULTS. Among 134 patients, 68 were treated with wire localization and 66 with radioguided localization. The mean duration of radiologic localization was significantly shorter for radioguided localization (p < 0.001). No statistical differences were found for the other parameters studied. Radiography of the surgical specimen showed 100% lesion excision with both techniques. Complete tumor excision with tumor-free margins was achieved in 89.4% of patients who underwent radioguided localization group and 82.4% of patients who underwent wire localization. Pathologic examination showed the excised tissue volume was slightly larger (p = 0.371) and lesion concentricity slightly less (p = 0.730) with radioguided localization. The sentinel node detection rate was 91% with radioguided localization and 84% with wire localization.

CONCLUSION. The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization.

MATERIALS AND METHODS. The study included 188,823 screening examinations of women between 50 and 64 years old; 35,204 (18.6%) mammograms were obtained using FFDM. All films were double read using a 5-point rating scale to indicate the probability of cancer. Patients with positive scores were recalled for further workup. The recall rate, cancer detection rate, and positive predictive value (PPV) of FFDM were compared with screen-film mammography.

RESULTS. The cancer detection rate was significantly higher for FFDM than screen-film mammography (6.3 vs 5.2 per 1,000, respectively; p = 0.01). The cancer detection rate for FFDM was higher than screen-film mammography for initial screening and subsequent screening, for invasive cancer and ductal carcinoma in situ, and across all age groups. The cancer detection rate for cancers presenting as microcalcifications was significantly higher for FFDM than for screen-film mammography (1.9 vs 1.3 per 1,000, p = 0.01). The recall rate was significantly higher for FFDM than screen-film mammography (4.0% vs 3.1%, p < 0.001). There was no significant difference in the PPVs of recall to assessment for FFDM and screen-film mammography (15.7% and 16.7%, p = 0.383).

CONCLUSION. FFDM resulted in significantly higher cancer detection and recall rates than screen-film mammography in women 50–64 years old. The PPVs of FFDM and screen-film mammography were comparable. The results of this study suggest that FFDM can be safely implemented in breast cancer screening programs.

MATERIALS AND METHODS. Estimated absorbed fetal dose was measured with a metal oxide semiconductor field effect transistor (MOSFET) dosimeter placed in the expected uterine location in an anthropomorphic phantom of a woman and scanned with 16- and 64-MDCT units of one vendor and a 64-MDCT unit of another vendor. A trauma chest, abdomen, and pelvis protocol and an abdomen and pelvis protocol were used. Absorbed uterine dose was measured directly from the MOSFET detector. The CTDI_vol for each protocol was recorded from the scanner console. Correlation between mean uterine dose and CTDI_vol was tested with a goodness of fit model.

RESULTS. The absorbed uterine dose ranged from 9.25 to 37.7 mGy. Absorbed fetal dose in the early first trimester correlated with CTDI_vol in a linear regression equation. For the 16-MDCT scanner, at 130 kVp, the fetal dose was 2.091 x CTDI_vol – 9.489. For the 64-MDCT scanner from the same vendor, at 120 kVp, the fetal dose was 1.113 x CTDI_vol + 1.773. For the 64-MDCT scanner from the other vendor, at 120 kVp, the fetal dose was 1.378 x CTDI_vol – 1.014. The goodness of fit results (R²) for the equations were 0.97, 0.98, and 0.99.

CONCLUSION. Estimated absorbed fetal dose during the first trimester of pregnancy is linearly associated with CTDI_vol regardless of beam energy, detector configuration, and scanner manufacturer.

MATERIALS AND METHODS. From September 2005 through December 2007, targeted ultrasound was performed for 519 suspicious MRI-detected lesions in 361 women. Retrospective review was performed to determine lesion type (mass vs nonmass), lesion descriptors, lesion size, BI-RADS category, indication for MR examination, patient age, and biopsy outcome. The results of 80 follow-up MRI examinations among 154 cases with concordant benign results on ultrasound-guided biopsy were noted.

RESULTS. A presumed ultrasound correlate was found in 290 (56%) of the 519 lesions with masses more likely than nonmass lesions to be seen with ultrasound (62% of masses and 31% of nonmass lesions). Increasing lesion size, assessment of BI-RADS category 5 versus BI-RADS category 4, rim enhancement in masses, and clumped enhancement in nonmass lesions were also significantly more likely to have an ultrasound correlate. On follow-up imaging in 80 benign, concordant ultrasound-guided biopsies, the sonographic lesion did not correspond to the MRI finding in 10. Nine of these 10 lesions underwent subsequent MRI-guided biopsy and five cancers were diagnosed.

CONCLUSION. The MR characteristics of lesions most likely to be seen with an ultrasound correlate were mass versus nonmass, increasing size, and increased level of suspicion of the lesion. Clip placement and follow-up imaging after ultrasound-guided biopsy that yields benign concordant results should be performed to detect cases in which the presumed ultrasound correlate is inaccurate to detect unsuspected false-negative biopsies.

SUBJECTS AND METHODS. Forty-five women (mean age, 46.1 years) with 52 focal mass breast lesions underwent diffusion-weighted imaging with different b values. The apparent diffusion coefficient (ADC) value of each lesion was calculated from the ADC maps done using five b values (0, 250, 500, 750, and 1,000 s/mm²) and using b values of 0 s/mm² with each other b value separately (0 and 250 s/mm², 0 and 500 s/mm², 0 and 750 s/mm², 0 and 1,000 s/mm²). The mean ADC values were correlated with imaging findings and histopathologic diagnoses. The cutoff ADC value, sensitivity, and specificity of diffusion-weighted imaging to differentiate benign and malignant lesions were calculated in all b value combinations. A p value of < 0.05 was considered statistically significant.

RESULTS. The mean ADC value was significantly lower for malignant lesions compared to benign lesions (p < 0.0001) in all b value combinations. No statistical difference was seen between the ADC obtained from different b value combinations (p = 0.2581) in the differentiation between benign and malignant lesions. The ADC calculated from b 0 and 750 s/mm² was slightly better than the other b value combinations, showing a sensitivity of 92.3% and a specificity of 96.2%.

CONCLUSION. Diffusion-weighted imaging is a potential resource as a coadjutant of MRI in the differentiation between benign and malignant lesions. Such imaging can be performed without a significant increase in examination time, especially because it can be done with lower b values.

MATERIALS AND METHODS. Ninety-six patients underwent breast DCE-MRI. The type of DCE-MRI kinetic curve was assessed qualitatively by three radiologists on two occasions. For quantitative assessment, the slope of the washout curve was calculated. Kappa statistics were used to determine inter- and intraobserver agreement for the qualitative method. Matched sample tables, the McNemar test, and receiver operating characteristic (ROC) curve statistics were used to compare quantitative versus qualitative methods for establishing or excluding malignancy.

RESULTS. Seventy-eight lesions (77.2%) were malignant and 23 (22.8%) were benign. For the qualitative assessment, the intra- and interobserver agreement was good ( = 0.76–0.88), with an area under the ROC curve (AUC) of 0.73–0.77. For the quantitative method, the highest AUC was 0.87, reflecting significantly higher diagnostic accuracies compared with qualitative assessment (p < 0.01 for the difference between the two methods).

CONCLUSION. Quantitative assessment of the type of contrast enhancement kinetic curve on breast DCE-MRI resulted in significantly higher diagnostic performance for establishing or excluding malignancy compared with assessment based on the standard qualitative method.