Current opinion in radiology最新文献

The role of breast sonography has been well defined as a supplement to clinical examination and mammography, but investigative attempts at refining and expanding that role continue. Several recent articles correlate pathologic results with either subjective or objective B-mode findings. The results of these investigations corroborate the conclusions of previous studies, particularly the conclusion that sonography has value in the differentiation of cystic from solid masses. Interest in Doppler ultrasound increased as color flow imaging became widely available, and recent work suggests potential for diagnostic differentiation of solid masses using Doppler technique.

Significant progress in early detection of malignancy has been achieved by the improvement of mammographic technique, the introduction of quality control, the demonstration of benefits from screening, and appropriate application of supplementary methods such as ultrasound, cytology, and stereotaxis. Certain problems in breast imaging, however, are still unsolved. These include early detection and exclusion of malignancy without microcalcifications in mammographically dense tissue (particularly in younger women), the still-limited accuracy of mammographic signs, and the management of diagnostic problems after surgery, radiation therapy, or silicone implants. Therefore, research is needed to further improve diagnostic capabilities. The research can be subdivided into different approaches: 1) further development of the mammographic technique (digital luminescence radiography); 2) evaluation of techniques that image other physical tissue properties (sonography, thermography, trans-illumination, CT, non-contrast-enhanced MR imaging, biomagnetism, biostereometry, and ductoscopy); 3) investigation of techniques that image metabolic changes (MR spectroscopy, positron-emission tomography) or metabolism-induced differences in perfusion or vascularity (Doppler ultrasound, contrast-enhanced MR imaging); and 4) development of techniques that attempt tissue diagnosis using monoclonal antibodies. Among these techniques, digital luminescence radiography and contrast-enhanced MR imaging are the most developed and the most promising. They are at the threshold of becoming clinically important. Doppler ultrasound could be useful for certain indications. Whereas MR spectroscopy, positron-emission tomography, the search for appropriate antibodies, and possibly transillumination, ductoscopy, and biomagnetism offer interesting new aspects for research, the value of CT, thermography, and biostereometry is not yet established.

Papers in the review period have investigated the reasons why radiologists frequently overlook early lung cancers and have demonstrated that the rate at which radiologists falsely categorize a solitary pulmonary nodule as benign, through the use of commercially available CT phantom densitometry is higher than was previously believed. Attempts have also been made to find CT characteristics other than density that may help to distinguish benign from malignant nodules. A number of articles have addressed methods of improving the yield and reducing the pneumothorax rate following needle biopsy of pulmonary nodules. The major role of the radiologist when evaluating patients with known or probable lung cancer is to stage the tumor. The recent literature describing the accuracy of CT and MR imaging in staging lung cancer is also reviewed.