Background:Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found.Aims:To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies.Study Design:Diagnostic accuracy study.Methods:Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery.Results:Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis.Conclusion:Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.

Background: The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed. Objective: To determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between total tumor volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings. Methods: Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean diffusivity (MD), Fractional anisotropy (FA), Radial diffusivity (RD) and TTV were calculated from the tumor. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered as group 2. The relationships between MD, RD, and FA values and TTV were investigated. Results: A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, and RD and MD values after radiosurgery. Conclusions: Detection of low FA values due to poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.

You may cite this article as: Oktay A, Aslan Ö, Taşkın F, et al. Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

Objectives: The aim of this study is to investigate whether white matter (WM) integrity is impaired in vitamin B12 and folate deficiency with Diffusion Tensor Imaging (DTI) in older patients. Methods: All the patients aged ≥65 years admitted to the geriatric clinic and performed DTI-MRI were included in the study. DTI parameters (fractional anisotropy, ADC, axial diffusivity, radial diffusivity) were calculated by ROI-based method in white matter tracts. Deficiency threshold for vitamin B12 were defined as <200 pg ml−1, and <400 pg ml−1 separately; and for folate as <3 ng ml−1, and <6 ng ml−1, separately. Results: DTI was performed to older patients having serum vitamin B12 level (n = 106, mean age = 80.7±7.7, 66% female) and folate level (n = 101, mean age = 80.7±7.5, 67.3% female). Significantly lower FA and higher ADC and RD levels were observed in multiple WM areas including superior and middle cerebellar peduncles, cingulum and genu of corpus callosum in patients with vitamin B12 <400 pg ml−1 (p < 0.05). DTI indices also showed significant changes in the genu of corpus callosum, and right and left superior longitudinal fasciculus in patients with folate <6 ng ml−1 (p < 0.05). Conclusions: Deficiencies of vitamin B12 and folate may be associated with impaired white matter integrity in elderly even at high laboratory levels, and DTI is a useful method to detect it. Advances in knowledge: Early detection of impaired WM integrity caused by micronutrient deficiencies poses a great significance in terms of prevention and intervention, and DTI is an effective non-invasive method to be used for this purpose.

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