Purpose:To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors. Materials and Methods:Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.Results: DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) and normal parenchyma (1.59 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) was detected (P Ͻ 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 ϫ 10 Ϫ5 mm 2 /s versus 1.15 ϫ 10 Ϫ5 mm 2 /s, P ϭ 0.053). Conclusion:The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. DYNAMIC CONTRAST MATERIAL-enhanced MRI, which gives information on morphology and kinetics and has higher sensitivity, is frequently used to identify additional lesions and to determine the extent of tumor before surgery (1). In recent years, some studies have attempted to differentiate between benign and malignant tumors using diffusion-weighted imaging (DWI) (2-9). DWI is a specific modality that visualizes the microstructural characteristics of water diffusion in biological tissues. The microscopic motion includes the molecular diffusion of water and blood microcirculation in capillary networks; therefore, both diffusion and perfusion affect apparent diffusion coefficient (ADC) values (2,10). The ADC value was determined to be lower in cancer compared with normal parenchyme or benign breast tumor (2-9). Many studies have attempted to predict treatment response and prognosis in patients with breast cancer. It has been disclosed that there are traditional prognostic factors such as tumor grade and molecular markers such as estrogen receptors (ER) and progesterone receptors (PR) (11). Of these prognostic factors, the histologic grade of the tumor and the Ki-67 proliferation index reflect the cellularity (5,8,12,13), and c-erbB-2 and ER are thought to be associated with perfusion (14,15). We have speculated that these prognostic factors can affect the ADC value.To our knowledge, no studies have examined the correlation between the ADC value and prognostic factors. The objectives of the current study are to examine the clinical usefulness of DWI for the detection of invasive cancer, and to determine whether the ADC value can be a new prognostic factor for patients with...

xillary lymph node status is the most important prognostic factor in breast cancer. 1 The presence of nodal metastases decreases 5-year survival by approximately 40% compared to node-negative patients. 2 Sentinel lymph node biopsy has replaced axillary lymph node dissection in patients with a low risk of axillary nodal metastases because of decreased morbidity. [3][4][5][6][7] Sentinel lymph node status is a representative indicator for the entire lymph node basin. However, false-negative results of sentinel lymph node biopsy have been found. 4,8,9 Noninvasive imaging techniques have been used to predict the preoperative axillary lymph node status. Sonography has higher diagnostic accuracy than mammography, computed tomography, magnetic resonance imaging, and positron emission tomographyJae Jeong Choi, MD, Bong Joo Kang, MD, PhD, Sung Hun Kim, MD, Ji Hye Lee, MD, Seung Hee Jeong, MPH, Hyun Woo Yim, MD, PhD, Byung Joo Song, MD, Sang Seol Jung, MD Received September 20, 2010, ORIGINAL RESEARCHObjectives-The purpose of this study was to evaluate the diagnostic utility of sonographic elastography in differentiating reactive and metastatic axillary lymph nodes in breast cancer.Methods-A total of 64 lymph nodes (reactive, n = 33; metastatic, n = 31) from 62 patients with breast cancer were examined by both B-mode sonography and elastography from April to July 2009. Two experienced radiologists retrospectively assessed B-mode sonograms by the sum of scores for 4 criteria: short diameter, shape, hilum, and cortical thickening. Elastographic images were given scores of 1 to 4 according to the percentage of high-elasticity areas in the lymph nodes. We compared the diagnostic performance of B-mode sonography, elastography, and combined examinations. We also calculated the strain ratio of the lymph node and subcutaneous fat tissue.Results-The elasticity score for malignant lymph nodes (mean, 3.1) was higher than the score for benign lymph nodes (mean, 2.2; P < .0001). With a cutoff between elasticity scores of 2 and 3, elastography showed 80.7% sensitivity, 66.7% specificity, and 73.4% accuracy. With a cutoff between B-mode sonographic scores of 1 and 2, B-mode sonography showed 74.2% sensitivity and 78.8% specificity. Combined B-mode and elastographic sonography showed higher sensitivity (87.1%) than B-mode sonography alone. With a strain ratio cutoff point of 2.3, sensitivity was 82.8%, and specificity was 56.3%.Conclusions-Sonographic elastography may increase the sensitivity of B-mode sonography in the detection of metastatic axillary lymph nodes.

Incidental hypermetabolic foci in the breast may represent malignancy in as many as 37.5% of cases. The SUV(max) and sonographic findings can be useful for differentiating benign from malignant lesions.

CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.