Objective: The current recommendation from the UK National Health Service Breast Screening Programme is that digital breast tomosynthesis (DBT) can be used for further assessment of possible screen-detected softtissue abnormalities in place of spot compression views and when used should be performed in two projections. The aim of the study was to assess whether twoview DBT is necessary if the abnormality is seen only in one view on initial full-field digital mammography (FFDM). Methods: 617 cases with possible masses, distortions and asymmetrical densities visualized only in one view on screening FFDM were included. All of these females underwent two-view DBT, clinical examination and ultrasound. The FFDM and DBT findings on each view were compared and correlated with the histological diagnosis.
This case reports on secondary extramedullary multiple myeloma within both breasts in the absence of axillary nodal involvement and discusses the difficulty in interpretation with clinical recommendations and learning outcomes. Differentiating plasmacytic lesions in the breast is often difficult as clinical and radiological appearances are known to mimic benignity and high-grade primary breast cancer. Extramedullary presentation can determine progression of the disease and can necessitate cross-sectional imaging. Therefore definitive diagnosis is essential as the clinical management of the patient may be altered.
Posterior reversible encephalopathy syndrome (PRES) is a syndrome characterised by reduced GCS/confusion, seizures and visual disturbance along with characteristic MRI findings. Autoimmune disorders have been identified in one third of patients with PRES.Here we discuss a 33-year-old female with SLE, who presented with reduced GCS and arm weakness. She had an AKI and metabolic acidosis and was admitted to ICU. Although the patients GCS improved, ongoing upper limb weakness remained. MRI imaging to rule out cerebral lupus, showed high T2 and FLAIR signal within the deep white matter of the occipital, frontal and parietal lobes. This was suggestive of PRES. Whilst in ICU the patient developed hypertension and was started on amlodipine. The patient also had a long history of immunosuppression with mycophenolate, hydroxychloroquine and rituximab. A neurology referral was sent for further advice.Although the name suggests, PRES is often not completely reversible and is not limited to the posterior cerebral cortex, as seen here. It still remains unclear whether it is the autoimmune condition or treatment of these conditions with immunosuppressant’s that is the primary association. Case reports linking PRES with immunosuppressant therapy have shown an early onset of symptoms following treatment, rather than years.
Digital breast tomosynthesis (DBT) addresses limitations of 2-D projection imaging for detection of masses. Microcalcification clusters may be more difficult to appreciate in DBT as individual calcifications within clusters may appear on different slices. This research aims to evaluate the performance of ImageChecker 3D Calc CAD v1.0. Women were recruited as part of the TOMMY trial. From the trial, 169 were included in this study. The DBT images were processed with the computer aided detection (CAD) algorithm. Three consultant radiologists reviewed the images and recorded whether CAD prompts were on or off target. 79/80 (98.8%) malignant cases had a prompt on the area of microcalcification. In these cases, there were 1-15 marks (median 5) with the majority of false prompts (n=326/431) due to benign (68%) and vascular (24%) calcifications. Of 89 normal/benign cases, there were 1-13 prompts (median 3), 27 (30%) had no prompts and the majority of false prompts (n=238) were benign (77%) calcifications. CAD is effective in prompting malignant microcalcification clusters and may overcome the difficulty of detecting clusters in slice images. Although there was a high rate of false prompts, further advances in the software may improve specificity.
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