CT imaging of peripheral pulmonary vessel disease

Abstracts / Journal of Clinical Imaging 30 (2006) 146 – 149 Negative predictive value of sonography and mammography in patients with focal breast pain Tumyan L, Hoyt AC, Bassett LW (Department of Radiological Sciences, 200 UCLA Medical Plaza, Suite 165-47, Box 956952, Los Angeles, CA 90095-6952). Breast J 2005;11:333–337. The purpose of this study was to determine the negative predictive value of mammography and sonography in a population of patients with focal breast pain referred for imaging evaluation. Eighty-six consecutive patients with focal breast pain in the absence of a breast mass were retrospectively identified from an imaging database. The electronic inpatient and outpatient records for the 86 patients were reviewed. For patients who were diagnosed with breast cancer, pathology reports were reviewed to determine whether the painful area corresponded to the patient’s cancer. In addition, patient records were linked to the institution’s cancer registry. Of the 86 patients, 26 patients were lost to follow-up and did not appear in the institution’s cancer registry. Four patients were diagnosed with breast carcinoma, two of whom had incidental cancers that were detected mammographically by microcalcifications and were separate from and unrelated to the area of pain. Seven patients underwent biopsy at the site of breast pain with benign diagnosis. Imaging and clinical follow-up for the 51 patients with benign or negative imaging at the site of pain showed no abnormality with a mean follow-up of 26.5 months. The negative predictive value of mammography and sonography in patients with breast pain was 100%. The negative predictive value of mammography and sonography for focal breast pain is high. Negative mammography and sonography can be reassuring to the treating clinician if follow-up is planned when physical examination is not suspicious. However, if physical examination is suspicious, biopsy should not be delayed.

Stereotactic vacuum-assisted breast biopsies in 500 women with microcalcifications: radiological and pathological correlations Kettritz U, Morack G, Decker T (Department of Radiology, Berlin-Buch Breast Unit, HELIOS Klinikum Berlin Medical Center, Wilbergstrasse 50, HS 120, D-13125 Germany). Eur J Radiol 2005;55:270 –276. Aim: We compared radiological assessment with pathological diagnoses in 500 consecutive vacuum-assisted breast biopsies performed for microcalcifications. Methods: Lesions were biopsied using a 11-gauge mammotome device. Before biopsy, microcalcifications were classified according to the Breast Imaging Reporting and Data System (BI-RADS). Histopathological and radiological diagnosis were compared. Results: Histopathology revealed 333 (67%) benign lesions. Benign lesions were classified as BI-RADS 3 in 19%, and as suspicious in 35%. 167 lesions (33%) were malignant. Malignant lesions were classified as suspicious or highly suggestive of malignancy in 63%. Frequency of malignancy in BIRADS categories 4 and 5 was 35% and 100%, respectively. In BI-RADS 3 microcalcifications, the malignancy frequency was 19%. The mammographic features with the highest positive predictive value for malignancies were pleomorphic morphology (42%) and a linear or segmental distribution (51%). The microcalcification morphology was not reliably able to predict malignancy. Conclusion: In this study, BI-RADS 3 microcalcification lesions had a malignancy rate that is higher than previously reported. Vacuum-assisted biopsy is useful in any indeterminate and suspicious microcalcifications and provides maximum information before any operative intervention.

Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid disease Mayer EJ, Fox DL, Herdman G, Hsuan J, Kabala J, Goddard P, Potts MJ, Lee RWJ (M.J.P.: Department of Diagnostic Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol B52 8HW, UK). Eur J Radiol 2005;56:20 –24.

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The signal intensity from inflamed extra-ocular muscles on short tau inversion recovery (STIR)-sequence magnetic resonance imaging (MRI) is known to correlate with clinical scores of thyroid eye disease (TED) severity. Twenty-one patients who had undergone repeated MRI scanning for TED were studied retrospectively. Signal intensity of extra-ocular muscles (from STIR-sequence MRI) and cross-sectional area (from STIR and T1 MRI) were correlated with Mounts’ clinical activity score (CAS). The area of highest signal intensity within the most inflamed extra-ocular muscle, and the average cross-sectional signal intensity of the most inflamed extra-ocular muscle reliably correlated with CAS, and this was maintained as disease activity changed over time. In contrast, isolated measures of muscle cross-sectional area did not correlate with CAS. The extra-ocular muscle cross-sectional area calculated from STIR-sequence MR images was greater than that measured on T1 images. This suggests that muscle area from STIR-sequence MRI may also detect peri-muscular inflammation. We conclude that the peak signal intensity from the most inflamed extra-ocular muscle remains the most reliable correlate of clinical disease activity obtained from these images. STIR-sequence MRI scans provide a number of useful measures of disease activity in TED.

CT imaging of peripheral pulmonary vessel disease Resten A, Maitre S, Musset D (D.M.: Service de Radiologie, Hoˆpital Antoine Be´cle`re, 157 rue de la Porte de Trivaux, F-92140 Clamart, France). Eur Radiol 2005;15:2045–2056. The diseases concerning the small pulmonary vessels are difficult to diagnose. Pathologic findings are rarely limited to the small vessels, and a continuum between the involvement of small and large vessels is frequent. Moreover, small vessels can be affected by various disease entities with overlapping radiologic features and a wide spectrum of clinical manifestations. Nevertheless, these various entities can be easily separated into two different groups by imaging techniques, particularly by computed tomography: obstructive and inflammatory diseases. Radiologic findings of obstructive diseases are relatively constant, dominated by the manifestation of pulmonary hypertension. In contrast, radiologic manifestations of inflammatory diseases are often florid and nonspecific. After a recall of the classification of small vessel diseases and the imaging techniques, we show the computed tomography features of the principal diseases involving the small pulmonary vessels by classifying them in these two principal groups.

Focal area of ground-glass opacity and ground-glass opacity predominance on thin-section CT: discrimination between neoplastic and nonneoplastic lesions Nambu A, Araki T, Taguchi Y, Ozawa K, Miyata K, Miyazawa M, Hiejima Y, Saito A (Department of Radiology, Yamanashi University, Shimokawato 1110, Tamaho-cho, Nakakoma-gun, Yamanashi Prefecture 400-3898, Japan). Clin Radiol 2005;60:1006 –1017.1 Aim: To reveal differences in thin-section computed tomography (CT) findings between lung neoplastic lesions and non-neoplastic lesions, which showed a focal area of ground-glass opacity or ground-glass opacity predominance. Materials and methods: A total of 82 focal areas of ground-glass opacity and ground-glass opacity predominance, consisting of 38 neoplastic and 44 non-neoplastic lesions, were assessed retrospectively regarding their thin-section CT findings. Results: The frequency of wholly well-defined margin ( P=.001), spiculation ( P=.019), pleural indentation ( P=.016), air bronchograms ( P=.027), air-containing space ( P=.004) was significantly higher in neoplastic lesions than in non-neoplastic lesions. Thirty-four of 38 (89%) neoplastic lesions were well-defined in more than 50% of the circumference, of which nine had an air-containing space other than air bronchogram, whereas only one non-neoplastic lesion had these features. 1

n 2005 The Royal College Radiologists, Reprinted with permission.