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Thứ Ba, 16 tháng 4, 2013

RADIOGRAPHICS 3-4/2013


Selected Abstracts

1.     Abstract 1

  CME ARTICLE

Breast Imaging:

Yiming Gao, Priscilla J. Slanetz, and Ronald L. Eisenberg

Continuing Medical Education: Echogenic Breast Masses at US: To Biopsy or Not to Biopsy? Radiographics March-April 2013 33:2 419-434; doi:10.1148/rg.332125048

Common benign and malignant breast lesions that can appear hyperechoic at US are reviewed, with emphasis on correlation with mammographic appearance, lesion location, and clinical history to determine the need for biopsy.

2.     Abstract 2

  CME ARTICLE

Breast Imaging:

Fanny Maud Pinel-Giroux, Mona M. El Khoury, Isabelle Trop, Christina Bernier, Julie David, and Lucie Lalonde

Continuing Medical Education: Breast Reconstruction: Review of Surgical Methods and Spectrum of Imaging Findings Radiographics March-April 2013 33:2 435-453; doi:10.1148/rg.332125108

Breast reconstruction that uses prosthetic implants and autologous tissue flaps of various kinds is described, and normal appearances as well as benign and malignant changes that may be observed in the reconstructed breast at US, mammography, and MR imaging are discussed to facilitate the accurate and timely detection of breast cancer recurrence at an early stage.

3.     Abstract 3

     CME ARTICLE

Breast Imaging:

Grant E. Lattin, Jr, Robert A. Jesinger, Rubina Mattu, and Leonard M. Glassman

Continuing Medical Education: From the Radiologic Pathology Archives: Diseases of the Male Breast: Radiologic-Pathologic Correlation Radiographics March-April 2013 33:2 461-489; doi:10.1148/rg.332125208

The clinical, radiologic, and pathologic features of a variety of benign and malignant tumors of the male breast are discussed, helping the radiologist to narrow the differential diagnosis, correctly identify the next step in the diagnostic workup, and provide effective feedback and recommendations to the pathologist and referring provider.

4.     Abstract 4

    CME ARTICLE

Genitourinary Imaging:

Rafael Oliveira Caiafa, Ana Sierra Vinuesa, Rafael Salvador Izquierdo, Blanca Paño Brufau, Juan Ramón Ayuso Colella, and Carlos Nicolau Molina

Continuing Medical Education: Retroperitoneal Fibrosis: Role of Imaging in Diagnosis and Follow-up Radiographics March-April 2013 33:2 535-552; doi:10.1148/rg.332125085

The basic concepts, clinical features, and imaging findings of retroperitoneal fibrosis are discussed, with emphasis on the key role of imaging in diagnosis and management.

1.     Abstract 1 of 4Breast ImagingContinuing Medical Education

Echogenic Breast Masses at US: To Biopsy or Not to Biopsy?

At ultrasonography (US), purely or predominantly echogenic breast masses are rare. These lesions were once assumed to be benign, but recent data suggest that approximately 0.5% of malignant breast lesions appear echogenic. However, correlation with the mammographic appearance, lesion location, and clinical history allows the need for biopsy to be determined. An echogenic mass that is radiolucent at mammography is benign. An echogenic mass that is not radiolucent at mammography may represent a hematoma, complex seroma, silicone granuloma, abscess, galactocele, or fat necrosis when the appropriate clinical history is present. In these cases, biopsy can usually be avoided. If there is a clinical history of cancer or radiation therapy, biopsy is often indicated to assess for metastasis or angiosarcoma. An echogenic mass in an ectatic duct warrants biopsy to exclude carcinoma. An echogenic skin lesion is most likely benign and can occasionally have peripheral vascularity due to surrounding inflammation. However, a skin lesion with internal vascularity is concerning for metastasis or lymphoma. If there is no suspicious clinical history, suspicious sonographic features or mammographic findings would lead to a recommendation for biopsy. Lesions with nonspecific imaging or clinical features (eg, angiolipoma or pseudoangiomatous stromal hyperplasia) may require biopsy to exclude malignancy.

© RSNA, 2013


2.     Abstract 2 of 4Breast ImagingContinuing Medical Education

Breast Reconstruction: Review of Surgical Methods and Spectrum of Imaging Findings

Breast reconstruction after mastectomy is often requested by women with breast cancer who are ineligible for breast-conserving therapy and women with a high genetic risk for breast cancer. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, a prosthetic implant, or both. Regardless of the technique used, cancer may recur in the reconstructed breast; in addition, in breasts reconstructed with autologous tissue flaps, benign complications such as fat necrosis may occur. To detect breast cancer recurrences at a smaller size than can be appreciated clinically and as early as possible without evidence of metastasis, radiologists must be familiar with the range of normal and abnormal imaging appearances of reconstructed breasts, including features of benign complications as well as those of malignant change. Images representing this spectrum of findings were selected from the clinical records of 119 women who underwent breast magnetic resonance (MR) imaging at the authors’ institution between January 2009 and March 2011, after mastectomy and breast reconstruction. In 32 of 37 women with abnormal findings on MR images, only benign changes were found at further diagnostic workup; in the other five, recurrent breast cancer was found at biopsy. Four of the five had been treated initially for invasive carcinoma, and one, for multifocal ductal carcinoma; three of the five were carriers of a BRCA gene mutation. On the basis of these results, the authors suggest that systematic follow-up examinations with breast MR imaging may benefit women with a reconstructed breast and a high risk for breast cancer recurrence.

3.     Abstract 3 of 4Breast ImagingContinuing Medical Education

From the Radiologic Pathology Archives1: Diseases of the Male Breast: Radiologic-Pathologic Correlation

Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.

4.     Abstract 4 of 4Genitourinary ImagingContinuing Medical Education

Retroperitoneal Fibrosis: Role of Imaging in Diagnosis and Follow-up

Retroperitoneal fibrosis (RPF) encompasses a range of diseases characterized by proliferation of aberrant fibroinflammatory tissue, which usually surrounds the infrarenal portion of the abdominal aorta, inferior vena cava, and iliac vessels. This process may extend to neighboring structures, frequently entrapping and obstructing the ureters and eventually leading to renal failure. The idiopathic form of RPF accounts for more than two-thirds of cases; the rest are secondary to factors such as drug use, malignancies, or infections. If promptly diagnosed and treated, idiopathic and most other benign forms of RPF have a good prognosis. In contrast, malignant RPF, which accounts for up to 10% of cases, has a poor prognosis. Therefore, the most important diagnostic challenge is differentiation of benign from malignant RPF. Imaging plays a key role in diagnosis of RPF. Cross-sectional imaging studies, particularly multidetector computed tomography (CT) and magnetic resonance (MR) imaging, are considered the imaging modalities of choice. Imaging features may help distinguish between benign and malignant RPF, but in some cases histopathologic examination of the retroperitoneal tissue is needed for definitive diagnosis. CT and MR imaging, along with positron emission tomography with fluorine 18 fluorodeoxyglucose, also play an important role in management and follow-up of idiopathic RPF.

© RSNA, 2013

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