The purpose of this multicenter study was to determine the accuracy and clinical value of a dedicated breast biopsy system which allows for MR-guided vacuum biopsy (VB) of contrast-enhancing lesions. In five European centers, MR-guided 11-gauge VB was performed on 341 lesions. In 7 cases VB was unsuccessful. This was immediately realized on postinterventional images or direct follow-up combined with histopathology-imaging correlation; thus, a false-negative diagnosis was avoided. Histology of 334 successful biopsies yielded 84 (25%) malignancies, 17 (5%) atypical ductal hyperplasias, and 233 (70%) benign entities. Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign histologic biopsy results were verified by retrospective correlation with the pre- and postinterventional MRI and by subsequent follow-up. Our results indicate that MR-guided VB, in combination with the dedicated biopsy coil, offers the possibility to accurately diagnose even very small lesions that can only be visualized or localized by MRI.

Our purpose was to report about technical success, problems and solutions, as experienced in a first multicentre study on MR-guided localisation or vacuum biopsy of breast lesions. The study was carried out at four European sites using a dedicated prototype breast biopsy device. Experiences with 49 scheduled localisation procedures and 188 vacuum biopsies are reported. Apart from 35 dropped indications, one localisation procedure and 9 vacuum biopsies were not possible (3 times space problems due to obesity, 2 times too strong compression, 3 times impaired access from medially, 2 times impaired access due to a metal bar). Problems due to too strong compression were recognised by repeat MR without compression. During the procedure problems leading to an uncertain result occurred in eight vacuum biopsies, two related to the procedure: one limited access, and one strong post-biopsy enhancement. Improvements after phase-I study concerned removal of the metal bar, development of an improved medial access, of a profile imitating the biopsy gun, optimisation of compression plates and improved software support. The partners agreed that the improvements answered all important technical problems.

SUMMARY The discovery of a large patent ductus venosus resulted from radiological investigations in a 34-year-old man, a chronic alcoholic of low mental status. Splenoportal and inferior caval venograms were performed because of recent exacerbation of the neurological symptoms and electroencephalographic criteria of portacaval encephalopathy. Portal pressure was 8 mm Hg. A liver scan, a laparoscopy, and a liver biopsy were performed. They showed that the gland was atrophic with a microscopic appearance of alcoholic fibrosis, but without any nodular regeneration. The relationship between the fistula, the mental state, and the atrophic liver is discussed. Such a malformation appears to be very uncommon.Radiological investigations in the diagnosis of liver dysfunction, especially cirrhosis, lead commonly to the discovery of portacaval shunts. Most of these connexions are explained by portal hypertension itself. Yet, in some cases, the anastomotic veins have an unusual topography, either splenorenal or umbilical, and it is reasonable to assume the preexistence of a spontaneous portacaval derivation.We recently observed a case of a large portacaval fistula with the radiological configuration of a persistent ductus venosus. Case ReportA 34-year-old man, a contruction worker of Italian origin, was admitted to the Montpellier University Hospital in March 1970 because of psychiatric symptoms of a few weeks' duration. He was a known alcoholic and these symptoms were at first related to his drinking. However, initial examination revealed a flapping tremor. The patient exhibited alternately indifference and agitation, and he became somnolent for a few days; normal consciousness reappeared rapidly and objective examination confirmed mental subnormality which probably preceded the recent psychiatric disturbance. Physical examination revealed no ascites or collateral circuPlease address requests for reprints to: Dr Paul Barjon, Cliniques Saint-Charles,

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