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Preoperative wire localization of breast lesions by tissue harmonic imaging (THI) sonography
Abstracts / Journal of Clinical Imaging 27 (2003) 136–139 MR – pathologic correlation of lung specimens Hatabu H, Uematsu H, Hasegawa I, Itoh H (Department of Radiology, Harvard Medical School, Beth Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215). Eur J Radiol 2002;44:210 – 215. The aim of this study was to assess the feasibility of a new MR – pathologic correlation method utilizing a high-resolution MR technique with a 3-in. surface coil and the elimination of susceptibility by replacing air in the pulmonary alveoli of lung specimens with water. Inflated cadaver lung specimens of various lung disorders were imaged using a conventional spin – echo (SE) sequence in a clinical 1.5-T MR scanner. The MR images were correlated with pathologic specimens. In six out of seven specimens, MR revealed detailed images corresponding to pathological changes. MR may provide a noninvasive and nondestructive method for examining lung specimens and for image – pathologic correlation.
Analysis of vascularity of breast tumors: comparison of high-frequency ultrasound and contrast-enhanced color harmonic imaging Schro¨der R-J, Bostanjoglo M, Hidajat N, et al. (Klinik f. Strahlenheilkund, Charite´, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany). Fortschr Ro¨ntgenstr 2002;174:1132 – 1141. Purpose: To compare the ability of standard power Doppler and color harmonic imaging (CHI) for visualising breast tumor vascularity using ultrasound probes of various frequencies and to evaluate the influence on diagnostic accuracy using ultrasound contrast agent. Materials and methods: Twenty patients (c = 43.6 ± 11.7 years) with suspected malignancy of the breast underwent power Doppler to evaluate vascularity and to offer a differential diagnosis of the lesion. Two criteria were used for differential diagnosis: The quantitative extent of vascularity (percentage vessel area [PVA]) and the qualitative assessment of vascular architecture. The following power Doppler modes were compared in every patient: Plain and enhanced (Levovist) 9- and 12-MHz standard power mode and enhanced 9-MHz CHI. Results: The PVA increased from a mean of 2.2 ± 2.9% (9 MHz standard plain) via 4.8 ± 4.1% (12 MHz standard plain), 9.7 ± 15.3% (9 MHz standard enhanced) and 17.4 ± 20.0% (9 MHz CHI enhanced) up to 19.4 ± 14.8% (12 MHz standard enhanced). The perceptibility of the vascular structure was best using the enhanced 12-MHz standard power mode, immediately followed by the enhanced 9-MHz CHI mode. The improved detection of vascular signal did not translate into improved diagnostic accuracy. The highest diagnostic accuracy (95%) was obtained using the enhanced 9-MHz CHI mode (criterion ‘‘PVA’’) and the enhanced 9-MHz standard power mode ( criterion ‘‘vascular structure’’), whereas the 12-MHz probes delivered insufficient diagnostic accuracy and very low specificity. Conclusion: Best quantitative and qualitative visualisation of the tumor vascularity was achieved using the enhanced 12-MHz standard power mode. Nevertheless, the highest diagnostic accuracy was obtained using the enhanced 9-MHz standard power Doppler and the enhanced 9-MHz CHI. The visualisation of tumor vascularity and, partially, the diagnostic accuracy are improved significantly by CHI without changing the probe frequently.
Preoperative wire localization of breast lesions by tissue harmonic imaging (THI) sonography Jung EM, Clevert D-A, Lutz R, et al. (Ro¨ntgeninstitut des Klinikums Passau, Bischof-Piligrim-Strasse 1, D-94032 Passau, Germany). Fortschr Ro¨ntgenstr 2002;174:1121 – 1125. Purpose: To obtain a fast and reliable preoperative wire localisation of occult lesions in dense breast tissue harmonic imaging (THI) sonography when localisation by mammography is not reliable enough.
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Materials and methods: In addition to biplane mammography for breast screening or for follow-up examination after breast-saving therapy, ultrasound was performed by two independent radiologists in 350 patients with mastophatic or fibrotic breast tissue. Using a multifrequency probe (5 – 10 MHz), lesions were documented by conventional B-mode and by THI in similar projections. In 25 lesions not precisely identified in mammography, sonographically guided puncture with wire localisation was performed. Results: In 22 of 350 patients, 25 circumscribed suspicious lesions with an average diameter of 8 mm were identified, regarded suspicious by ultrasound but not by mammography. Nineteen of the 25 lesions were found by M-Mode and THI, and an additional six by THI only. Guided puncture and wire localisation was achieved in 10 min on the average. In B-mode, the course of needle and wire was reliably seen in 16 out of 25 cases, in THI in all cases. After surgical removal of tissue, histopathology revealed a ductal or lobular carcinoma in 19 cases, metastasis in 3 cases and benign complicated cysts with fibrotic tissue in the remaining 3 cases. Conclusion: THI is superior to B-mode ultrasound in differentiating suspicious lesions in dense glandular breast tissue. If tumor signs in mammography are not reliable enough or if a precise localisation is not possible, sonographically guided puncture by THI can give reliable results and is, furthermore, faster and more comfortable for the patient than localisation by mammography.
The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions Moss HA, Barter SJ, Nayagam M, et al. (Dr. SJ Barter Beds & Herts Breast Screening Service, Luton and Dunstable Hospital NHS Trust, Lewey Road, Luton, Bedfordshire, LU4 0DZ, UK). Clin Radiol 2002;57:937 – 944. Aim: To determine the accuracy and therapeutic success of localisation of impalpable breast lesions by bookwire with additional lesion marking with carbon suspension to mark screen detected abnormalities requiring surgical excision. Materials and methods: Retrospective review of all breast localisation procedures performed in our unit on women with a screen detected abnormality requiring excision over a 7-year period. Results: A total of 138 women underwent breast localisation procedures. All of the mammographic abnormalities were excised at the initial surgical procedure. The benign to malignant ratio was 1:2. Preoperative cytology was used to guide the extent of surgical excision, with clear margins in 79 of the 92 patients (75%) with malignancy. Twenty patients had further surgery: mastectomy in 7 and further local excision in 14. The localisation procedure was a therapeutic success in the local excision of malignancy in 73 of the 92 patients (79%) with the malignancy. Conclusion: This method of localisation biopsy is an accurate technique for surgical excision of mammographically detected impalpable abnormalities. The surgeon is able to choose the site of surgical incision to give the best cosmetic result, the lesion is easier to identify at operation and the confidence that the abnormality has been excised is improved.
Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease Miao YM, Koh DM, Amin Z, et al. (Department of Gastroenterology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK). Clin Radiol 2002;57:913 – 918. Aim: Determining bowel disease activity in Crohn’s patients can be difficult on clinical and laboratory assessment. Endoscopy is invasive, and barium studies use ionising radiation. The aim of this study was to compare ultrasound and magnetic resonance imaging (MRI) in detecting Crohn’s disease activity in the small or large bowel.
Analysis of vascularity of breast tumors: comparison of high-frequency ultrasound and contrast-enhanced color harmonic imaging Schro¨der R-J, Bostanjoglo M, Hidajat N, et al. (Klinik f. Strahlenheilkund, Charite´, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany). Fortschr Ro¨ntgenstr 2002;174:1132 – 1141. Purpose: To compare the ability of standard power Doppler and color harmonic imaging (CHI) for visualising breast tumor vascularity using ultrasound probes of various frequencies and to evaluate the influence on diagnostic accuracy using ultrasound contrast agent. Materials and methods: Twenty patients (c = 43.6 ± 11.7 years) with suspected malignancy of the breast underwent power Doppler to evaluate vascularity and to offer a differential diagnosis of the lesion. Two criteria were used for differential diagnosis: The quantitative extent of vascularity (percentage vessel area [PVA]) and the qualitative assessment of vascular architecture. The following power Doppler modes were compared in every patient: Plain and enhanced (Levovist) 9- and 12-MHz standard power mode and enhanced 9-MHz CHI. Results: The PVA increased from a mean of 2.2 ± 2.9% (9 MHz standard plain) via 4.8 ± 4.1% (12 MHz standard plain), 9.7 ± 15.3% (9 MHz standard enhanced) and 17.4 ± 20.0% (9 MHz CHI enhanced) up to 19.4 ± 14.8% (12 MHz standard enhanced). The perceptibility of the vascular structure was best using the enhanced 12-MHz standard power mode, immediately followed by the enhanced 9-MHz CHI mode. The improved detection of vascular signal did not translate into improved diagnostic accuracy. The highest diagnostic accuracy (95%) was obtained using the enhanced 9-MHz CHI mode (criterion ‘‘PVA’’) and the enhanced 9-MHz standard power mode ( criterion ‘‘vascular structure’’), whereas the 12-MHz probes delivered insufficient diagnostic accuracy and very low specificity. Conclusion: Best quantitative and qualitative visualisation of the tumor vascularity was achieved using the enhanced 12-MHz standard power mode. Nevertheless, the highest diagnostic accuracy was obtained using the enhanced 9-MHz standard power Doppler and the enhanced 9-MHz CHI. The visualisation of tumor vascularity and, partially, the diagnostic accuracy are improved significantly by CHI without changing the probe frequently.
Preoperative wire localization of breast lesions by tissue harmonic imaging (THI) sonography Jung EM, Clevert D-A, Lutz R, et al. (Ro¨ntgeninstitut des Klinikums Passau, Bischof-Piligrim-Strasse 1, D-94032 Passau, Germany). Fortschr Ro¨ntgenstr 2002;174:1121 – 1125. Purpose: To obtain a fast and reliable preoperative wire localisation of occult lesions in dense breast tissue harmonic imaging (THI) sonography when localisation by mammography is not reliable enough.
137
Materials and methods: In addition to biplane mammography for breast screening or for follow-up examination after breast-saving therapy, ultrasound was performed by two independent radiologists in 350 patients with mastophatic or fibrotic breast tissue. Using a multifrequency probe (5 – 10 MHz), lesions were documented by conventional B-mode and by THI in similar projections. In 25 lesions not precisely identified in mammography, sonographically guided puncture with wire localisation was performed. Results: In 22 of 350 patients, 25 circumscribed suspicious lesions with an average diameter of 8 mm were identified, regarded suspicious by ultrasound but not by mammography. Nineteen of the 25 lesions were found by M-Mode and THI, and an additional six by THI only. Guided puncture and wire localisation was achieved in 10 min on the average. In B-mode, the course of needle and wire was reliably seen in 16 out of 25 cases, in THI in all cases. After surgical removal of tissue, histopathology revealed a ductal or lobular carcinoma in 19 cases, metastasis in 3 cases and benign complicated cysts with fibrotic tissue in the remaining 3 cases. Conclusion: THI is superior to B-mode ultrasound in differentiating suspicious lesions in dense glandular breast tissue. If tumor signs in mammography are not reliable enough or if a precise localisation is not possible, sonographically guided puncture by THI can give reliable results and is, furthermore, faster and more comfortable for the patient than localisation by mammography.
The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions Moss HA, Barter SJ, Nayagam M, et al. (Dr. SJ Barter Beds & Herts Breast Screening Service, Luton and Dunstable Hospital NHS Trust, Lewey Road, Luton, Bedfordshire, LU4 0DZ, UK). Clin Radiol 2002;57:937 – 944. Aim: To determine the accuracy and therapeutic success of localisation of impalpable breast lesions by bookwire with additional lesion marking with carbon suspension to mark screen detected abnormalities requiring surgical excision. Materials and methods: Retrospective review of all breast localisation procedures performed in our unit on women with a screen detected abnormality requiring excision over a 7-year period. Results: A total of 138 women underwent breast localisation procedures. All of the mammographic abnormalities were excised at the initial surgical procedure. The benign to malignant ratio was 1:2. Preoperative cytology was used to guide the extent of surgical excision, with clear margins in 79 of the 92 patients (75%) with malignancy. Twenty patients had further surgery: mastectomy in 7 and further local excision in 14. The localisation procedure was a therapeutic success in the local excision of malignancy in 73 of the 92 patients (79%) with the malignancy. Conclusion: This method of localisation biopsy is an accurate technique for surgical excision of mammographically detected impalpable abnormalities. The surgeon is able to choose the site of surgical incision to give the best cosmetic result, the lesion is easier to identify at operation and the confidence that the abnormality has been excised is improved.
Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease Miao YM, Koh DM, Amin Z, et al. (Department of Gastroenterology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK). Clin Radiol 2002;57:913 – 918. Aim: Determining bowel disease activity in Crohn’s patients can be difficult on clinical and laboratory assessment. Endoscopy is invasive, and barium studies use ionising radiation. The aim of this study was to compare ultrasound and magnetic resonance imaging (MRI) in detecting Crohn’s disease activity in the small or large bowel.