Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.

Purpose To investigate the feasibility of using simultaneous breast MRI and PET to assess the synergy of MR pharmacokinetic and fluorine-18 fluorodeoxyglucose (18F-FDG) uptake data to characterize tumor aggressiveness in terms of metastatic burden and Ki67 status. Methods Twelve consecutive patients underwent breast and whole body PET/MRI. During the MR scan, PET events were simultaneously accumulated. MR contrast kinetic model parametric maps were computed using the extended Tofts model, including the volume transfer constant between blood plasma and the interstitial space (Ktrans), the transfer constant from the interstitial space to the blood plasma (kep), and the plasmatic volume fraction (Vp). Results Patients with systemic metastases had a significantly lower kep compared to those with local disease (0.45 vs 0.99 min−1, p=0.011). Metastatic burden correlated positively with Ktrans and standardized uptake value (SUV), and negatively with kep. Ki67 positive tumors had a significantly greater Ktrans compared to Ki67 negative tumors (0.29 vs 0.45 min−1, p=0.03). A negative correlation was found between metabolic tumor volume and transfer constant (Ktrans or Kep). Conclusion These preliminary results suggest that MR pharmacokinetic parameters and FDG-PET may aid in the assessment of tumor aggressiveness and metastatic potential. Future studies are warranted with a larger cohort to further assess the role of pharmacokinetic modeling in simultaneous PET/MRI imaging.

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The individual radiologist and technologist influenced the frequency of RAI for US examinations, whereas other examination-related factors did not. The observed substantial variability in RAI between radiologists and technologists warrants further study, with consideration of strategies to optimize RAI within US reports.

For indeterminate liver and renal lesions detected on ultrasound, MRI is more likely to provide DD and less likely to provide RAI in comparison with CT, although these differences did not result in lower anticipated imaging costs.