MATERIALS AND METHODS. We evaluated 45,007 initial short-interval follow-up mammograms from the Breast Cancer Surveillance Consortium interpreted 3–9 months after a probably benign assessment on a screening or diagnostic examination between 1994 and 2004. We linked these mammograms with patient characteristics and breast cancer diagnoses within 12 months. A subset of short-interval follow-up examinations (n = 13,907) was merged with radiologist characteristics collected from survey data from 130 interpreting radiologists. Using logistic regression, we fit generalized estimating equations to model sensitivity and specificity of short-interval follow-up mammograms by patient and radiologist characteristics.

RESULTS. For every 1,000 women, 8.0 women (0.8%) were diagnosed with breast cancer within 6 months and 11.3 (1.1%) within 12 months. Sensitivity was 83.3% (95% CI, 79.4–87.3%) for cancers diagnosed within 6 months and 60.5% (56.2–64.7%) for those diagnosed within 12 months. Specificity was 97.2% (96.9–97.6%) at 6 months and 97.3% (96.9–97.6%) at 12 months. Sensitivity at 12 months increased among women with unilateral short-interval follow-up mammograms (odds ratio, 1.56 [95% CI, 1.06–2.29]) and when the interpreting radiologist spent more than 10 hours a week in breast imaging (odds ratio, 3.25 [1.00–10.52]).

CONCLUSION. Initial short-interval follow-up mammography examinations had a lower sensitivity for detecting breast cancer within 12 months than other diagnostic mammograms (61% for short-interval follow-up vs 80% for diagnostic mammograms reported in the literature). However, sensitivity within the 6-month interval that is usually recommended for subsequent follow-up was 83%. Accuracy of short-interval follow-up mammograms was influenced by few patient and radiologist characteristics.

SUBJECTS AND METHODS. We prospectively classified 4,668 breast sonograms according to BI-RADS final assessment category. Suspicious sonographic findings were divided into major and minor suspicious findings. Category 1 was normal and category 2 was a benign finding such as cyst or nodule with uniform and intense hyperechogenicity. A nodule neither category 2 nor category 4 or 5 was defined as category 3. A nodule with one or more suspicious findings, not category 5, was defined as category 4. A nodule with two or more major suspicious findings was defined as category 5.

RESULTS. Of the 4,668 cases, 321 cases failed to undergo follow-up of at least 1 year. The PPV was 0.1% in category 1 (3/2,191), 0% in category 2 (0/773), 0.8% in category 3 (6/737), 31.1% in category 4 (161/519), and 96.9% in category 5 (123/127). In palpable lesions (n = 751), the PPV was 2.2% in category 1 (2/93), 0.9% in category 3 (2/217), 54% in category 4 (107/198), and 98% in category 5 (98/100). In nonpalpable lesions (n = 3,596), the PPV was 0.05% in category 1 (1/2,098), 0.8% in category 3 (4/520), 16.8% in category 4 (54/321), and 92.6% in category 5 (25/27).

CONCLUSION. As with mammography, placing sonographic lesions into BI-RADS categories is useful for predicting the presence of malignancy.

SUBJECTS AND METHODS. Between January 2002 and December 2004, 40 fetuses with isolated CDH and 450 control subjects were prospectively evaluated in two centers. Fetal lung volumes were estimated on 3D sonography using the rotational technique and fetal weight on 2D sonography using the Hadlock equation. The ratio of sonographic fetal lung volume to body weight was calculated in each case and was correlated with neonatal deaths using the Mann-Whitney U test. Accuracies of the ratio in predicting neonatal deaths and pathologic diagnosis of pulmonary hypoplasia were also evaluated.

RESULTS. The ratio of sonographic fetal lung volume to body weight is constant throughout gestation, with a mean value of 0.025. The ratio was significantly lower in neonates that died (median, 0.009; range, 0.004–0.021) than in those that survived (median, 0.011; range, 0.008–0.020) (p = 0.018). Pulmonary hypoplasia was suspected prenatally in 34 of 40 (85.0%) fetuses with CDH, in all cases of death (100%), and in seven of nine (77.8%) neonates that survived. At autopsy, pulmonary hypoplasia was diagnosed in 19 cases (86.4%). Accuracies of the ratio in predicting neonatal deaths and pulmonary hypoplasia were 64.5% (20/31) and 86.4% (19/22), respectively.

CONCLUSION. The sonographic fetal lung volume–body weight ratio can be used more accurately to diagnose pulmonary hypoplasia than to predict neonatal deaths in fetuses with isolated CDH. Further studies are necessary to show the prevalence of pulmonary hypoplasia in fetuses with isolated CDH and its importance for predicting neonatal deaths.

MATERIALS AND METHODS. Contrast-enhanced pelvic 1.5-T MRI was performed in 49 women before and after UAE over a 2-year period. Dominant (largest diameter) fibroids in intramural, submucosal, subserosal, pedunculated subserosal, and endocavitary locations were assessed on pre- (baseline) and postembolization MRI. Size, locations of dominant fibroids relative to endometrium and serosa before and after embolization were compared. The ratio between the largest endometrial interface and the maximum dimension of the dominant submucosal fibroid (interface–dimension ratio) was determined on baseline MRI. The infarction rate for dominant fibroids was estimated after UAE.

RESULTS. One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface–dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p < 0.005; 8 vs 5.4 cm, p < 0.05, respectively). All dominant submucosal fibroids showed 100% infarction after UAE.

CONCLUSION. Submucosal fibroids with an interface–dimension ratio of greater than 0.55 are more likely to migrate into the endometrial cavity after UAE. The majority of these are expelled spontaneously without significant symptoms. Rarely, submucosal fibroids greater than 6 cm in size that become endocavitary may cause postprocedural complications requiring further intervention and medical treatment.

CONCLUSION. UAE can infarct fibroids. Fibroids spontaneously infarct after childbirth. Because the postpartum cervix is patulous, infarcted fibroids that fall into the uterine cavity easily exit the uterus. Each patient contemplating UAE should anticipate that infarcted fibroids bordering on or inside the uterine cavity may require cervical dilatation or hysteroscopic resection for removal. The addition of either of these two gynecology procedures should not necessarily be regarded as a UAE complication or treatment failure.

CONCLUSION. Hirschsprung's disease is rare in girls and bilateral hydrosalpinx is also extremely uncommon in sexually inactive adolescents. We think there may be a possible common cause: either a postsurgical complication or a congenital defect of the autonomous innervation in the context of a neurocristopathy. Because of the rarity of both conditions, the association is unlikely to be coincidental. The cause of this association is unclear and further studies are required to find its prevalence and to estimate the possible impact on fertility.

MATERIALS AND METHODS. A review was performed of 231,221 screening mammograms interpreted by experienced mammographers from 2001 through 2005 in a community-based mammography program. In 112,413 (48.6%), mammographers performed the first of two readings. In 118,808 (51.4%), they performed a single reading aided by CAD.

RESULTS. For double reading, the first reader's recall rate was 10.2%; sensitivity, 81.4%; positive predictive value, as a percentage of positive screening mammograms resulting in a tissue diagnosis of cancer within 1 year (PPV₁), 4.1%; and cancer detection rate, 4.12 per 1,000. After the double-reading process, the final recall rate was 11.9%; sensitivity, 88.0%; PPV₁, 3.7%; and cancer detection rate, 4.46 per 1,000. For single-reading with CAD, the recall rate was 10.6%; sensitivity, 90.4%; PPV₁, 3.9%; and cancer detection rate, 4.20 per 1,000. Statistically significant results included a lower recall rate with CAD compared with double reading (10.6% vs 11.9%, respectively; p < 0.0001); increased sensitivity with CAD compared with the first reader (90.4% vs 81.4%, p < 0.0001); and increased recall rate with CAD compared with the first reader (10.6% vs 10.2%, p < 0.0001).

CONCLUSION. Double reading increased sensitivity with a modest increase in the recall rate compared with single reading. Single reading with CAD, compared with double reading, resulted in a small, but not statistically significant, increase in sensitivity with a lower recall rate. Our results indicate that CAD enhances performance of a single reader, yielding increased sensitivity with only a small increase in recall rate.

MATERIALS AND METHODS. Estimated absorbed fetal dose was measured using a metal oxide semiconductor field effect transistor (MOSFET) dosimeter that was placed in the uterus of an adult female anthropomorphic phantom. The phantom was scanned on a 16-MDCT scanner using three protocols. The scanning parameters for protocol A (trauma) were detector configuration, 16 x 0.625 mm; pitch, 1.75:1; rotation time, 0.5 second; 140 kVp; and 340 mA. The scanning parameters for protocol B (CT angiography) were detector configuration, 16 x 1.25 mm; pitch, 1.38:1; rotation time, 0.6 second; 140 kVp; and 300 mA. The scanning parameters for protocol C, which is the automated tube current modulation (ATCM) protocol previously used in the literature, were detector configuration, 16 x 1.25 mm; pitch, 0.938:1; rotation time, 0.5 second; 140 kVp; and 380 mA. The protocols were also modified for the ATCM mode; the CTDI_vol was documented from the scanner's console. Correlation between these data was tested with a goodness-of-fit model.

RESULTS. Absorbed fetal radiation dose in the early first trimester correlated with the CTDI_vol via a linear regression equation. For a constant tube current and peak voltage of 140 kVp, fetal dose (mGy) = 1.665 x CTDI_vol (mGy) – 7.059. For the ATCM mode and a constant kVp of 140, fetal dose (mGy) = 2.151 x CTDI_vol (mGy) – 2.200. The goodness of fit (R²) for the equations is 0.99 and 0.91, respectively.

CONCLUSION. In both the manual and ATCM modes, absorbed fetal radiation dose can be estimated from the CTDI_vol obtained at the time of scanning independent of pitch and tube current–time product (mAs).

MATERIALS AND METHODS. Thirty selected cases were read under three different display conditions by nine experienced radiologists in a fully crossed, mode-balanced observer performance study. The reading modes included full-field digital mammography (FFDM) alone, the 11 low-dose projections acquired for the reconstruction of tomosynthesis images, and the reconstructed digital breast tomosynthesis examination. Observers rated cases under the free-response receiver operating characteristic, as well as a screening paradigm, and provided subjective assessments of the relative diagnostic value of the two digital breast tomosynthesis–based image sets as compared with FFDM. The time to review and diagnose each case was also evaluated.

RESULTS. Observer performance measures were not statistically significant (p > 0.05) primarily because of the small sample size in this pilot study, suggesting that showing significant improvements in diagnosis, if any, will require a larger study. Several radiologists did perceive the digital breast tomosynthesis image set and the projection series to be better than FFDM (p < 0.05) for diagnosing this specific case set. The time to review, interpret, and rate the examinations was significantly different for the techniques in question (p < 0.05).

CONCLUSION. Tomosynthesis-based breast imaging may have great potential, but much work is needed before its optimal role in the clinical environment is known.

MATERIALS AND METHODS. We reviewed the hysterosalpingograms of 150 women with a history of cesarean section. The incidence, location, and appearance of defects at the expected location of a hysterotomy scar were evaluated.

RESULTS. Of the 148 patients with history of cesarean section and technically adequate hysterosalpingograms, 89 (60%) had defects that were in the expected location of a hysterotomy incision. Fifty-eight (65%) of the diverticula were focal outpouchings, and 31 (35%) were thin linear defects. Forty-eight (54%) of the diverticula were located at the lower uterine cavity, 32 (36%) at the uterine isthmus, and nine (10%) at the upper endocervical canal.

CONCLUSION. A diverticulum at the lower uterine cavity, uterine isthmus, or upper endocervical canal is a common finding on hysterosalpingography in patients with a history of cesarean section.

MATERIALS AND METHODS. Between September 2003 and April 2005, 80 women (mean age, 43.5 years; range, 26–78 years) underwent sonohysterography with both conventional 2D sonohysterography and 3D multiplanar imaging (volume of data acquired and reconstructed in the transverse, sagittal, and coronal planes). Three blinded readers interpreted the 2D scans alone and then the 2D and 3D images together. Visualization of endometrial abnormality (polyps, fibroids, or septations) and definition of fundal contour were scored by each reader on a three-point scale (1, visualized; 2, unsure; 3, not visualized). Wilcoxon's signed rank test was used to assess mean differences between findings. Reader agreement was determined with the kappa statistic. Pathologic correlation was performed when the findings were available.

RESULTS. Average (mean ± SD) reader scores for identification of endometrial abnormality were not significantly different: 1.70 ± 0.91 for 2D alone versus 1.69 ± 0.92 for 2D and 3D combined (p = 0.38). There also was no significant difference when polyps (2.14 ± 0.90 vs 2.12 ± 0.93), fibroids (2.57 ± 0.79 vs 2.53 ± 0.82), and septations (2.88 ± 0.39 vs 2.87 ± 0.42) were evaluated separately. Average scores for definition of fundal contour were significantly (p < 0.0001) different (2.93 ± 0.34 for 2D alone versus 1.45 ± 0.80 for 2D and 3D combined). Agreement between readers was found with average kappa values of 0.72 for 2D alone and 0.78 for 2D and 3D. For the 42 subjects for whom pathologic findings were available, readers identified 92% of the abnormalities.

CONCLUSION. Three-dimensional reformations improve visualization of the uterine fundus and aid in identification or exclusion of a fundal contour abnormality but do not add value in the detection of endometrial abnormalities.

CONCLUSION. Synchrotron radiation imaging depicted microcalcifications as small as 24 µm. Imaging with this technique revealed that most amorphous and pleomorphic calcifications on conventional mammograms are clusters of fine specks and that in addition to the shape or density of a speck, the distribution density of clustered specks is a factor determining the apparent shape.