Radiology最新文献

Background Women with high background parenchymal enhancement (BPE) at contrast-enhanced MRI have up to a fourfold increased risk of breast cancer, even after adjusting for breast density. However, no studies have examined BPE specifically among Black women, despite their higher breast cancer-specific mortality and typically lower breast density. Purpose To examine Black-White racial differences in contrast-enhanced MRI-derived BPE. Materials and Methods This retrospective cross-sectional study examined the data of Black and White women without a history of breast cancer who underwent both mammography and subsequent MRI as part of a screening or diagnostic workup between January 2016 and December 2023. BPE was assessed qualitatively according to the Breast Imaging Reporting and Data System as high (ie, moderate or marked) or low (ie, minimal or mild). Logistic regression was performed to assess the association between race and high BPE, and mediation analysis was performed to explore the extent to which density accounted for racial differences in BPE. Results A total of 388 Black women and 2101 White women were included, with mean ages of 47 years ± 10 [SD] and 48 years ± 11, respectively. Fewer Black women had extremely dense breasts at mammography (43 of 388 [11%] vs 435 of 2101 [21%]; P = .01). The proportions of both groups exhibiting high BPE at breast MRI were similar (38% vs 33%; P = .11). According to mediation analysis, Black women were 31% more likely to have high BPE levels after density differences were eliminated (odds ratio, 1.28; 95% CI: 1.01, 1.64; P = .03). Conclusion In this preliminary examination of BPE as a breast MRI marker for the risk of invasive breast cancer, Black women were more likely than White women to have high BPE, despite the latter typically having greater breast density.

History: A 66-year-old man with a history of hypertension presented with left-sided jaw jerking, repetitive movements, aphasia, and dysarthria. He was afebrile and in no acute distress, with mild hypertension (153/81 mm Hg). Routine laboratory studies were unremarkable. Brain MRI showed multiple nonenhancing supratentorial, cortical, and subcortical hyperintensities on T2-weighted fluid-attenuated inversion recovery images, which were nonspecific for infectious, inflammatory, vascular, or neoplastic etiologies. CT of the chest, abdomen, and pelvis and MRI of the cervical and thoracic spine were unremarkable. CT angiography of the head and neck showed no areas of stenosis or occlusion. Extensive infectious, autoimmune, and paraneoplastic serologic tests were negative, including serum acetylcholinesterase, antinuclear antibody, erythrocyte sedimentation rate, C-reactive protein, aquaporin 4 and myelin oligodendrocyte glycoprotein (MOG) antibodies, treponemal testing, Tropheryma whipplei, human immunodeficiency virus, tick-borne disease panel, and COVID-19. Lumbar puncture showed 2% neutrophils (reference range, <6%), with normal protein and glucose levels. Cerebral spinal fluid studies, including protein electrophoresis, JC virus, herpes simplex virus polymerase chain reaction, MOG antibodies, cytologic examination, and a paraneoplastic panel (Table), were negative. The patient was treated with nicardipine and levetiracetam, with clinical improvement. A presumptive clinical diagnosis of posterior reversible encephalopathy syndrome was made, with plans for short-interval surveillance imaging and possibly brain biopsy, which the patient initially declined. He was subsequently lost to follow-up. Three years later, he experienced several months of progressive mood alterations followed by the development of psychosis and two generalized tonic-clonic seizures. At readmittance, he was again afebrile and in no acute distress, with mild hypertension (150/70 mm Hg). His neurologic examination was remarkable only for symmetric hyperreflexia. Repeat laboratory testing, including human immunodeficiency virus and hepatitis serologic tests, remained negative. Lumbar puncture showed 1% neutrophils, with normal protein and glucose levels and absent oligoclonal bands. MOG antibodies and an autoimmune encephalitis panel (Table) were negative. Repeat brain MRI was performed (Figs 1-3).

History: A previously healthy 33-year-old woman presented with several months of intermittent right upper quadrant discomfort, early satiety, bloating, and nausea. She had no remarkable past medical or surgical history, specifically no known malignancy, chronic liver disease, or substance abuse. She had four biologic children and reported no current or prior oral contraceptive use. Physical examination revealed normal vital signs and a soft, nontender abdomen. Laboratory studies included a hepatic function panel, which was normal. Results for serum tumor marker tests included an α-fetoprotein level of 2.1 μg/L (reference range, ≤8.3 μg/L), a carcinoembryonic antigen level less than 0.6 μg/L (reference range, ≤5.0 μg/L), and a cancer antigen 19-9 level of 17.4 kU/L (reference range, ≤35.0 kU/L). A urine pregnancy test was negative. CT of the abdomen and pelvis with intravenous contrast material was performed. No extrahepatic pathologic features were identified. MRI of the abdomen without and with intravenous contrast material was performed, for further evaluation of the liver findings.

Breast US is an essential breast imaging tool that complements mammography and MRI. US is also often the primary imaging modality used to evaluate palpable breast masses and axillary lymph nodes and to guide percutaneous biopsy of breast masses and lymph nodes. Screening whole-breast US, with either handheld or automated technique, serves as a supplementary modality to screening mammography, particularly in women with dense breasts. Artificial intelligence (AI) has been adopted in US examinations to improve diagnostic accuracy and workflow. Analysis and quantification of background echotexture are emerging as a novel biomarker for breast cancer risk assessment. As US technology evolves and the scope of breast US widens, radiologists must understand the current and emerging US technology. They must also apply meticulous US scanning techniques to optimize image quality and ensure accurate diagnosis. This review provides a state-of-the-art summary of US technology and clinical applications as an adjuvant technique to mammography, MRI, and the clinical breast examination. The utility of breast US for screening, preoperative staging, and neoadjuvant treatment monitoring for breast cancer, breast intervention, and new techniques including AI, US tomography, optoacoustic imaging, and contrast-enhanced US will also be presented.

Background Volumetric evaluation of liver and spleen size is useful, yet pediatric reference values remain limited and lack external validation. Purpose To establish normative liver and spleen volumes from contrast-enhanced CT in children and validate them in external regional and international datasets. Materials and Methods In this retrospective study, contrast-enhanced abdominal CT scans (patient age, 2-18 years) from Asan Medical Center and Pusan National University Yangsan Hospital (January 2005 to June 2021) were collected for the derivation dataset. Patients with chronic diseases, liver and/or spleen imaging abnormalities, or missing height and/or weight measurement within 3 months were excluded. Portal-phase CT images were segmented automatically with manual correction. Data from Seoul National University Children's Hospital (January 2018 to December 2021) and Cincinnati Children's Hospital Medical Center (January 2018 to July 2021) were used for regional and international validation, respectively. Model performance was assessed with the average pinball loss and absolute errors for predicting 50th percentiles. Results A total of 1298 children (median age, 11.3 years [IQR, 8.0-15.0 years]; 660 female) were included (derivation set, n = 1030 [all Asian]; regional validation set, n = 114 [all Asian]; international validation set, n = 154 [racially diverse]). The model including sex, height, and weight had the lowest average pinball loss for predicting 50th percentile liver (54.50 mL) and spleen (18.64 mL) volume and was therefore selected. Compared with previously published formulas, the model showed lower average pinball loss in the regional validation dataset for both liver (5th, 11.55 mL vs 11.93 mL; 50th, 50.88 mL vs 55.47-116.02 mL; 95th, 15.85 mL vs 19.49 mL) and spleen volumes (5th, 3.69 mL vs 3.74 mL; 50th, 15.19 mL vs 16.03 mL; 95th, 5.01 mL vs 5.59 mL). In international external validation, the average pinball loss was lower for the 50th percentiles (liver, 50.28 mL vs 50.30 mL; spleen, 20.97 mL vs 21.42 mL), and absolute errors were comparable (liver, 100.56 mL vs 100.60 mL [P = .53]; spleen, 41.93 mL vs 42.83 mL [P = .69]). Conclusion Normative liver and spleen volumes in children derived using quantile regression models and the respective predictive performance were presented. © RSNA, 2026 Supplemental material is available for this article.