The aim of this study was the evaluation of the diagnostic usefulness of ductal or segmental enhancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging finding is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unselected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients undergoing bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients' final diagnoses were established by imaging guided excisional or core biopsy or by clinical plus conventional imaging follow-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for patients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mammogram. The overall prevalence of a ductal or a segmental enhancement pattern on breast MRI is low. But this finding has a high specificity and a moderate positive predictive value for intraductal neoplastic changes. We conclude that if segmental or linear enhancement is identified on breast MRI further work-up is necessary. We recommend either direct MR-guided vacuum-assisted core biopsy or short-term follow-up breast MRI within 3 months. If ductal enhancement then persists, MR-guided biopsy should be recommended even in the absence of mammographically visible signs of DCIS.

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The purpose of this study was to evaluate if 3.0 T allows for clinically useful pelvic magnetic resonance imaging, i.e. if familiar image quality and tissue contrast can be achieved at 3.0 T as compared with at 1.5 T. Adapting a 1.5-T protocol to the 3.0-T environment is subject to a variety of factors. In order to reduce the number of potential variables, we chose two cornerstones: the 3.0-T sequence should have similar spatial resolution and acquisition time; furthermore, the contrast parameters repetition time (TR) and echo time (TE) were kept identical. Based on this modified 3.0-T T2-weighted turbo spin-echo sequence (TR/TE 2,705/80 ms; 0.7x1.04x4 mm measured voxel size; field of view 360 mm; 4.03-min scan time) we performed an intraindividual study on 19 patients with the 1.5-T sequence as the standard of reference. Two radiologists analyzed the examinations in consensus with regard to tissue contrast (visualization of zonal anatomy of the uterus and/or delineation of pathologic findings) rated on a three-point scale (3 is 3.0 T better; 2 is 3.0 T equal; 1 is 3.0 T worse than 1.5 T). In addition, the signal difference between muscle and bone marrow was measured as a marker for tissue contrast. The analysis of the image quality comprised the level of the artifacts (rated on a five-point scale: 1 is no artifacts; 5 is nondiagnostic study), the visual signal-to-noise ratio (rated on a three-point scale) and detail delineation. Only minor artifacts were observed at both 1.5 and 3.0 T; the difference was not statistically significant. The visual signal-to-noise ratio and the delineation of image details were rated equal for 1.5 and 3.0 T. With regard to image contrast, both qualitative analysis as well as quantitative analysis revealed comparable image contrast for the 1.5- and 3.0-T protocols. Pathological findings were seen equally well with both field strengths. Clinically diagnostic pelvic studies of high image quality can be obtained using a 3.0-T scanner with our modified examination protocol. To fully exploit the capability of the high-field technique, and to point out potential advantages, further intraindividual studies are needed, with the adjustment of other imaging parameters to the high-field environment.

In this proton magnetic resonance spectroscopy ((1)H-MRS) study, the authors correlated cognitive improvement after 3 months of treatment with donepezil with changes of N-acetylaspartate (NAA) level and NAA/Creatine (Cr) ratio in the medial temporal and parietal lobe of 17 patients with Alzheimer disease. Treatment response was associated with an increase of NAA and NAA/Cr in the parietal lobe. Low baseline NAA/Cr in the parietal lobe predicted positive treatment outcome.

Objective: To investigate group differences and correlations and to determine the sensitivity and specificity of different measures of the neuronal marker N-acetylaspartate (NAA) in the medial temporal lobe of Alzheimer’s Disease (AD) patients. Methods: The metabolic ratio NAA/creatine (Cr), the absolute concentration of NAA referenced against brain tissue (BT) water and NAA multiplied with the amount of BT in the proton magnetic resonance spectroscopy (1H-MRS) voxel were assessed in patients and healthy controls with a single-voxel 1H-MRS protocol. Results: All measures were significantly lower in AD patients compared with controls. NAA/Cr and NAA correlated weakly, and there was no correlation of NAA with the amount of BT in the voxel. The highest specificity (87%) at a sensitivity of 80% was observed for NAA multiplied with the amount of BT in the voxel. There was no correlation of the MMSE with any of the NAA parameters. Conclusions: NAA/Cr does not reflect NAA concentration very well. NAA is not correlated with brain atrophy. The BT volume in the 1H-MRS voxel in combination with the concentration of NAA discriminates AD from healthy controls sufficiently.