Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. Key Points • The recommendations in Figure 1 summarize the key points of the manuscript

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In this study, our purpose was to determine whether T2-weighted images are a useful diagnostic adjunct for lesion characterization in dynamic breast MRI. On a 1.5-T system, 205 enhancing benign and malignant breast tumors were examined. The standardized protocol consisted of a T2-weighted turbo spin echo (TSE) pulse sequence with and without spectral fat suppression (SPIR), followed by a two-dimensional dynamic series with subtraction postprocessing. In 59 cases, T2*-weighted gradient-echo images also were obtained. Two independent radiologists visually rated the lesions (101 malignant, 104 benign) as having either a low or a high signal with respect to the adjacent glandular tissue. To assess age dependency of lesion enhancement velocities and T2-TSE signal intensities, we compared the results for patients at or below the age of 50 (group A), between 40 and 50 (group B), and beyond the age of 50 (group C). In T2-weighted TSE images, breast cancers were iso-or hypointense with respect to breast parenchyma in 87% of cases, whereas fibroadenomas were hyperintense in 71%. Visual assessment of lesion appearance in T2-weighted TSE images allowed to distinguish between fibroadenomas and breast cancers, with a respective sensitivity, specificity, positive predictive value, and negative predictive value of 72%, 75%, 46%, and 90% for young patients; 94%, 66%, 78%, and 89% for the patients between 40 and 50; and 89%, 62%, 85%, and 68% for the patients over 50 years of age. No significant difference was found for the distribution of signal intensities of lesions in T2*-weighted images or in fat-suppressed images. In a contrast-enhancing breast lesion, careful analysis of T2-weighted TSE images can improve differential diagnosis. The accuracy of this criterion varies with age. J. Magn.

Purpose To address the lack of prospective data on the real-life clinical application of trans-arterial radioembolization (TARE) in Europe, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) initiated the prospective observational study CIRSE Registry for SIR-Spheres® Therapy (CIRT). Materials and Methods Patients were enrolled from 1 January 2015 till 31 December 2017. Eligible patients were adult patients treated with TARE with Y90 resin microspheres for primary or metastatic liver tumours. Patients were followed up for 24 months after treatment, whereas data on the clinical context of TARE, overall survival (OS) and safety were collected. Results Totally, 1027 patients were analysed. 68.2% of the intention of treatment was palliative. Up to half of the patients received systemic therapy and/or locoregional treatments prior to TARE (53.1%; 38.3%). Median overall survival (OS) was reported per cohort and was 16.5 months (95% confidence interval (CI) 14.2–19.3) for hepatocellular carcinoma, 14.6 months (95% CI 10.9–17.9) for intrahepatic cholangiocarcinoma. For liver metastases, median OS for colorectal cancer was 9.8 months (95% CI 8.3–12.9), 5.6 months for pancreatic cancer (95% CI 4.1–6.6), 10.6 months (95% CI 7.3–14.4) for breast cancer, 14.6 months (95% CI 7.3–21.4) for melanoma and 33.1 months (95% CI 22.1–nr) for neuroendocrine tumours. Statistically significant prognostic factors in terms of OS include the presence of ascites, cirrhosis, extra-hepatic disease, patient performance status (Eastern Cooperative Oncology Group), number of chemotherapy lines prior to TARE and tumour burden. Thirty-day mortality rate was 1.0%. 2.5% experienced adverse events grade 3 or 4 within 30 days after TARE. Conclusion In the real-life clinical setting, TARE is largely considered to be a part of a palliative treatment strategy across indications and provides an excellent safety profile. Level of evidence Level 3. Trial registration ClinicalTrials.gov NCT02305459.