By using a receiver operating characteristic approach and a standardized set of chest radiographs, observer accuracy and variability are easily quantified. This approach provides a basis for comparing the diagnostic performance of physicians. When value is measured as a diminution in uncertainty, board-certified radiologists contribute substantial value to the diagnostic imaging system.

Rationale & objectivesWe sought to develop an abbreviated protocol (AP) for breast MRI that maximizes lesion detection by assessing each lesion not seen on mammography by each acquisition from a full diagnostic protocol (FDP).Materials & methods671 asymptomatic women (mean 55.7 years, range 40–80) with a negative mammogram were prospectively enrolled in this IRB approved study. All lesions on MRI not visualized on mammography were analyzed, reported, and suspicious lesions biopsied. In parallel, all FDP MRI acquisitions were scored by lesion to eventually create a high-yield AP.ResultsFDP breast MRI detected 452 findings not visible on mammography, including 17 suspicious lesions recommended for biopsy of which seven (PPV 41.2%) were malignant in six women. Mean size of the four invasive malignancies was 1.9 cm (range 0.7–4.1), all node negative; three lesions in two women were ductal carcinoma in situ. Nine biopsied lesions were benign, mean size 1.2 cm (range 0.6–2.0). All biopsied lesions were in women with dense breasts (heterogeneously or extremely dense on mammography, n = 367), for a cancer detection rate of 16.3/1000 examinations in this subpopulation. These data were used to identify four high-yield acquisitions: T2, T1-pre-contrast, T11.5, and T16 to create the AP with a scan time of 7.5 min compared to 24 min for the FDP.ConclusionsOur analysis of a FDP MRI in a mammographically negative group identified four high-yield acquisitions that could be used for rapid screening of women for breast cancer that retains critical information on morphology, histopathology, and kinetic activity to facilitate detection of suspicious lesions.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-017-4112-0) contains supplementary material, which is available to authorized users.

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Magnetic resonance imaging using a 1.5 tesla magnet and a spin echo technique has revealed a remarkably intense signal from abnormal tissue in the human paranasal sinuses. Inflammatory disease in the maxillary, sphenoid, ethmoid, and frontal sinuses has been detected and demonstrated with greater clarity than any other available technique. The pathophysiologic basis for the intense signal has not been defined. These observations do, however, provide an opportunity to discover, clarify, and study paranasal sinus disease. Acute upper respiratory disease, allergic episodes, and the effect of drug treatment based on the MR signal and pathology can now be investigated with this technique. In addition, this may form a basis for assessing the epidemiology of paranasal sinus pathology.