New MRI features, especially from T2-weighted images, are promising for more reliable and accurate interpretation of breast lesions. Prospective studies of these findings are required to define cut-off values and test clinical practicality.

Phyllodes breast tumors and other fibroadenomas cannot be precisely differentiated on breast MRI. Phyllodes tumors have benign morphologic features and contrast enhancement characteristics suggestive of malignancy in 33% of cases.

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Percutaneous cryotherapy is a feasible and safe procedure in minimally invasive therapy for small breast cancers. Residual ductal carcinoma in situ may be attributable to the beginning of a learning curve or by false-negative detection in pre-interventional imaging. Magnetic resonance mammography might aid in treatment planning and for therapy monitoring to better define target tissue and to correlate the tumor margin with the ice-ball.

The aim of this study was to investigate the potential and feasibility of ultrasound-guided cryotherapy in breast cancer. Fifteen female patients with 16 breast cancers (mean tumour diameter 21±7.8 mm) were treated. A 3-mm cryo probe was placed in the tumour under ultrasound guidance. Two freeze/thaw cycles with durations of 7-10 min and 5 min, respectively, were performed. The size of the iceballs was measured sonographically in 1-min intervals. The patients underwent surgery within 5 days and the specimens were evaluated histologically. The mean diameter of the iceball was 28±2.7 mm after the second freezing cycle. No severe side effects were observed. Five tumours with a diameter below 16 mm did not show any remaining invasive cancer after treatment. Two of these had ductal carcinoma in situ (DCIS) in the surrounding tissue. In 11 patients cryotherapy of tumours reaching diameters of 23 mm or more resulted in incomplete necrosis. This study shows that the invasive components of small tumours can be treated using cryotherapy. Remnant DCIS components which may not be detected preinterventionally represent a challenging problem for complete ablation. In tumours larger than 15 mm two or more cryo probes should be used to achieve larger iceballs.

Complex networks of both natural and engineered flow paths control the hydrology of streams in major cities through spatio-temporal variations in connection and disconnection of diverse water sources. We used spatially extensive and temporally intensive sampling of water stable isotopes to disentangle the hydrological sources of the heavily urbanized Panke catchment ($220 km 2 ) in the north of Berlin, Germany. The isotopic data enabled us to partition stream water sources across the catchment using a Bayesian mixing analysis. The upper part of the catchment streamflow is dominated by groundwater ($75%) from gravel aquifers. In dry summer periods, streamflow becomes intermittent in the upper catchment, possibly as a result of local groundwater abstractions. Storm drainage dominates the responses to precipitation events. Although such events can dramatically change the isotopic composition of the upper stream network, storm drainage only accounts for 10%-15% of annual streamflow. Moving downstream, subtle changes in sources and isotope signatures occur as catchment characteristics vary and the stream is affected by different tributaries. However, effluents from a wastewater treatment plant (WWTP), serving 700,000 people, dominate stream flow in the lower catchment ($90% of annual runoff) where urbanization effects are more dramatic. The associated increase in sealed surfaces downstream also reduces the relative contribution of groundwater to streamflow. The volume and isotopic composition of storm runoff is again dominated by urban drainage, though in the lower catchment, still only about 10% of annual runoff comes from storm drains. The study shows the potential of stable water isotopes as inexpensive tracers in urban catchments that can provide a more integrated understanding of the complex hydrology of major cities. This offers an important evidence base for guiding the plans to develop and re-develop urban catchments to protect, restore, and enhance their ecological and amenity value.

The aim of this study was to determine the tumour detection rate and false positive rate of a new mammographic computer-aided detection system (CAD) in order to assess its clinical usefulness. The craniocaudal and oblique images of 150 suspicious mammograms from 150 patients that were histologically proven to be malignant were analysed using the Second Look CAD (CADx Medical Systems, Quebec, Canada). Cases were selected randomly using the clinic's internal tumour case sampler. Correct marking of the malignant lesion in at least one view was scored as a true positive. Marks not at the location of the malignant lesion were scored as false positives. In addition, mammograms with histologically proven benign masses ( n=50) and microcalcifications ( n=50), as well as 100 non-suspicious mammograms, were scanned in order to determine the value of false-positive marks per image. The 150 mammograms included 94 lesions that were suspicious due to masses, 26 due to microcalcifications and 30 showed both signs of malignancy. The overall sensitivity was 90.0% (135 of 150). Sensitivity on subsets of the data was 88.7% (110 of 124) for suspicious masses (MA) and 98.2% (55 of 56) for microcalcifications. Eight of 14 false-negative cases were large lesions. The overall false-positive rate was observed as 0.28 and 0.97 marks per image of microcalcifications and masses, respectively. The lowest false-positive rates for microcalcifications and MA were observed in the cancer subgroup, whereas the highest false-positive rates were scored in the benign but mammographically suspicious subgroups, respectively. The new CAD system shows a high tumour detection rate, with approximately 1.3 false positive marks per image. These results suggest that this system might be clinically useful as a second reader of mammograms. The system performance was particularly useful for detecting microcalcifications.

The aim of this study was to evaluate potential diagnostic relevance of blooming effect for verification of suspicious breast lesions in MR mammography (MRM). The MRM examinations of 1035 patients, all following the same imaging protocol (from 1994 to 2001) were retrospectively evaluated by two experienced radiologists in consensus. A total of 817 lesions showed a focal enhancement; of these, 793 were histologically verified after surgical intervention so that 514 malignant and 279 benign lesions could be evaluated. Using a 1.5-T Gyroscan ACS II-imager (Philips, Hamburg, Germany) and a double breast coil with the patient lying in a prone position, 0.1 mmol/kgbw Magnevist (Schering, Berlin, Germany) were injected into the cubital vein to obtain dynamic axial and coronal T1-weighted fast-field-echo images every minute up to 7 min after bolus injection. Blooming sign describes a progradient unsharpness of lesion borders initially sharply shaped and fast enhancing 7 min after bolus injection; 324 of 514 (63.0%) malignant lesions and 41 of 279 (14.7%) benign lesions revealed a blooming sign (sensitivity 63.0%, specificity 85.3%, accuracy 70.9%, positive predictive value 88.8%, negative predictive value 56.0%). Forty-one of 279 benign lesions showed a blooming sign; of these, there were 4 of 86 (4.7%) fibroadenomas, 2 of 21 (9.5%) phylloides tumours, 11 of 38 (28.9%) papillomas, 3 of 9 (33.3%) radial scars, 2 of 19 (10.5%) mastitis, 1 of 4 (25%) galactophoritis, 1 of 3 (33.3%) ADH and 19 of 99 (17.2%) mastopathic proliferations, respectively. Blooming sign is a phenomenon which should be taken into account when diagnosing MR mammographies because it might increase the ability to discriminate uncertain breast lesions; however, this effect can only be used as an additional item to other well-known effects such as plateau, washout and cancer corner.