In the last decade, there have been huge advances in the field of breast imaging. Full field digital mammography systems optimise lesion to background contrast with resultant improvement in the sensitivity of the technique for cancer detection, facilitated by computer-aided detection. Though mammography remains the only established modality for population-based screening, preliminary results from several large studies indicate that magnetic resonance imaging (MRI) has a role in high-risk patients. On the other hand, advances in ultrasound, MRI and nuclear medicine have the potential to greatly improve the specificity of breast imaging with regard to cancer detection and lesion characterisation. A number of new and experimental techniques are being developed which may have great impact in this area and these will be discussed. Though MRI now has an established place in the diagnosis of breast cancer, it is becoming clear that it can directly affect surgical and medical management by enabling assessment of response to chemotherapy and endocrine therapy, and facilitating choice of the most appropriate surgery. Just as the role of MRI has evolved, so too the place of nuclear medicine, particularly positron emission tomography and radio-immunoscintigraphy should become clearer in the next few years.

Midgut neuroendocrine tumors (MNETs) are rare, and the primary tumor is usually small and difficult to visualize at imaging. Patients often present late with extensive liver and nodal metastases and may experience symptoms secondary to the release of active substances by the primary tumor, such as serotonin and its metabolites, which have local and systemic effects. Locally, this causes desmoplasia and vascular encasement and may lead to small bowel obstruction and ischemia, with significant morbidity and mortality. Systemically, the release of active substances into the circulation can cause flushing, diarrhea, and abdominal pain (carcinoid syndrome); these substances can be detected in urine and blood serum and used as markers for diagnosis and treatment follow-up. MNETs retain expression of specific peptide receptors such as somatostatin receptors, which will bind to synthetic somatostatin analogs such as octreotide. This feature is useful for functional imaging of patients with MNETs and for peptide receptor radionuclide therapy using somatostatin analogs. Resection of the primary tumor is advocated, even in patients with extensive metastases, because it may prevent development of local complications, can help control systemic symptoms, and has been shown to confer some survival advantage. Computed tomography and functional imaging are used to identify the primary tumor and assess its resectability. The main factors governing resectability are patient comorbidities (eg, carcinoid heart disease), vascular involvement, and desmoplasia.

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Purpose: The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that avoids radiation exposure would be desirable. Our purpose was to assess the diagnostic performance of MRI, before and after administration of mangafodipir trisodium (MnDPDP), in the detection of neuroendocrine liver metastases. Methods: Patients who had undergone single-phase or multi-phase contrast-enhanced MD-CT for neuroendocrine liver metastases were invited to have MRI. Two independent observers made quantitative measurements (number and size of lesions). All measurements were made on each available CT phase and all MRI sequences independently, and repeated after an interval to assess reproducibility. The final number of lesions was agreed on by consensus of three observers. A qualitative assessment (contrast and spatial resolution) and preferred modality were agreed on by consensus. Results: 265 lesions were detected by consensus in 11 patients. Non-contrast CT was available in 4/11, arterial phase in 6/11 and portal phase in 10/11 patients. When compared with the consensus number of lesions, MD-CT identified 17% on non-contrast, 44% on arterial and 43% on portal venous imaging. Lesion detection on MRI was 48% on T₁W, 52% on T₂W and 92% on MnDPDP-MRI. The number of lesions detected on MnDPDP-MRI was closest to the final consensus reading (variance = 0.994, p = 0.0027). The reproducibility of lesion size measurements was best on MnDPDP-MRI (variance = 0.033, p = 0.0021). The preferred modality subjectively was MnDPDP-MRI in 9/11 cases and T₂W MRI in 2/11. Conclusion: MRI is a robust technique in the demonstration of neuroendocrine liver metastases. It is highly reproducible in both detecting the number and measuring the size of lesions. We recommend T₂W MRI and MnDPDP-MRI in detection and follow-up of neuroendocrine liver metastases.