OBJECTIVE-The type of contrast enhancement kinetic curve (i.e., persistently enhancing, plateau, or washout) seen on dynamic contrast-enhanced MRI (DCE-MRI) of the breast is predictive of malignancy. Qualitative estimates of the type of curve are most commonly used for interpretation of DCE-MRI. The purpose of this study was to compare qualitative and quantitative methods for determining the type of contrast enhancement kinetic curve on DCE-MRI.MATERIALS AND METHODS-Ninety-six patients underwent breast DCE-MRI. The type of DCE-MRI kinetic curve was assessed qualitatively by three radiologists on two occasions. For quantitative assessment, the slope of the washout curve was calculated. Kappa statistics were used to determine inter-and intraobserver agreement for the qualitative method. Matched sample tables, the McNemar test, and receiver operating characteristic (ROC) curve statistics were used to compare quantitative versus qualitative methods for establishing or excluding malignancy.RESULTS-Seventy-eight lesions (77.2%) were malignant and 23 (22.8%) were benign. For the qualitative assessment, the intra-and interobserver agreement was good (κ = 0.76-0.88), with an area under the ROC curve (AUC) of 0.73-0.77. For the quantitative method, the highest AUC was 0.87, reflecting significantly higher diagnostic accuracies compared with qualitative assessment (p < 0.01 for the difference between the two methods).CONCLUSION-Quantitative assessment of the type of contrast enhancement kinetic curve on breast DCE-MRI resulted in significantly higher diagnostic performance for establishing or excluding malignancy compared with assessment based on the standard qualitative method. Keywords breast cancer; breast imaging; contrast-enhanced MRI; dynamic MRI; kinetic curve; washout Contrast-enhanced MRI carries very high sensitivity but moderate specificity for the diagnosis of breast cancer [1,2]. Dynamic contrast-enhanced MRI (DCE-MRI) has been widely used to improve the specificity of MRI in characterizing breast lesions [3][4][5][6][7]. The NIH Public Access Materials and Methods Clinical SubjectsMRI scans of 300 consecutive patients who presented to our facility for bilateral breast MRI from January 2007 to February 2008 were retrospectively reviewed. Patients were included in the study if they had a breast lesion or lesions at least 1 cm in diameter that had a pathologically proven diagnosis or 2 years of imaging follow-up accepted as a proof of benignity. This study was approved by our institutional review board and was compliant with HIPAA.Ninety-one patients met the inclusion criteria of the study. Patients were scanned on either a 1.5-T (48 patients) or a 3-T (48 patients) clinical MRI system (1.5-T Intera and 3-T Achieva, Philips Healthcare) using a bilateral dedicated phased-array breast coil (4-channel breast array coil, Invivo). The MRI protocol included 2 minutes of high-temporal-resolution imaging (15 seconds per acquisition) to capture the wash-in phase of contrast enhancement, high-spatial-resolution ...

Background: The aim of this study was to investigate the diagnostic efficiency of magnetic resonance (MR) spectroscopy with diffusion-weighted imaging in the evaluation of the recurrent contrast-enhancing regions at the location of treated gliomas. Patients and Methods: In 49 patients who had new contrast-enhancing lesions at the vicinity of previously resected and irradiated high-grade gliomas, single-voxel MR spectroscopy and diffusion-weighted imaging were performed. Spectral data for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), lipid (Lip), and lactate (Lac) were analyzed in combination with the apparent diffusion coefficient (ADC) in all patients. Diagnosis of these lesions was allocated by means of follow-up or histopathology. Results: The Cho/NAA and Cho/Cr ratios were significantly higher in recurrent tumor group than in radiation injury group (p < 0.001). The ADC values and ADC ratios (quotient of ADC of contrastenhancing lesion and matching structure in the contralateral hemisphere) were significantly higher in radiation injury regions than in recurrent tumor (p< 0.001). With MR spectroscopy, two variables (Cho/NAA and Cho/Cr ratios) were proved to differentiate recurrent glioma from radiation injury, and 81.5% of total patients were classified into correct groups. Using discriminant analysis for MR spectroscopy with diffusion-weighted imaging, three independent variables (Cho/NAA, Cho/Cr, and ADC ratio) could classify 91% of total patients into their correct groups. There was a significant difference between the diagnostic accuracy of the two discriminant analyses (Chi-square=4.15, p=0.042). Conclusion: MR spectroscopy combined with ADC ratio can enhance the ability to differentiate recurrent glioma from radiation injury.

BackgroundAppendicitis is the most common surgical emergency in children; yet, diagnosis of equivocal presentations continues to challenge clinicians.AimThe objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS) may improve the accuracy in diagnosing acute appendicitis in the pediatric population.Patients & MethodsMain outcome measuresSensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS) incorporating clinical judgment and results of gray scale ultrasonography (US) was applied- were reviewed and compared to the data of 265 pediatric patients with equivocal diagnosis of acute appendicitis (AA), to whom a modified clinical practice grading scores (MCPGS) was applied. Statistical analyses were carried out using Z test for comparing 2 sample proportions and student's t-test to compare the quantitative data in both groups. Sensitivity and specificity for the 2 scoring systems were calculated using Epi-Info software.ResultsThe Number of appendectomies declined from 200 (75.5%) in our previous CPGS to 187 (70.6%) in the MCPGS (P > 0.05).Specificity was significantly higher when applying MCPGS (90.7%) in this study compared to 70.47% in our previous work when CPGS was applied (P < 0.01). Furthermore, the positive predictive value (PPV) was significantly higher (95.72%) than in our previous study (82.88%), (P < 0.01). Overall agreement (accuracy) of MCPGS was 96.98%. Kappa = 0.929 (P < 0.001). Negative predictive power was 100%. And the Overall agreement (accuracy) was 96.98%.ConclusionsMCPGS tends to help in reduce the numbers of avoidable and unnecessary appendectomies in suspected cases of pediatric acute appendicitis that may help in saving hospital resources.

Objectives It is not certain from current evidence which patient groups with non-visible haematuria (NVH) require urgent investigation and which investigations are sufficient. We report referral outcomes data from Scotland to identify patient groups who will benefit from urgent assessment to rule out urological cancer (UC) and whether full set of investigations are necessary in all referred patients. Materials and methods Data were collected from electronic patient records for patients referred with NVH to secondary care urology services between July 2017 and May 2020. The correlations between risk factors and final diagnosis were assessed using categorical variables in a multivariate logistic regression analysis and using chi-squared models. Statistical analysis was performed using IBM SPSS data editor version 25. Results Our study cohort comprised 525 patients (43.4% males; median age 66 years), in which UC was diagnosed in 25 patients (4.8%). Age > 60 years had sensitivity and NPV for UC of 92% and 99%, respectively. Univariate and multivariate analysis showed male sex, age ≥ 60 years and smoking were significant predictors of UC in patients with NVH (p < 0.05). There was no significant difference in UC in patients with history of LUTS, anticoagulation and previous UC. Conclusion The risk of urologic cancer in NVH patients is significant and male gender, age ≥ 60 years and smoking are significant predictors of UC. Patients with risk factors of UC require complete assessment of both the upper and lower urinary tract; however, in the absence of risk factors, patients do not require urgent or complete assessment.

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