Background Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of pituitary microadenomas; however, it may be associated with a relatively high false-negative rate, especially in small lesions. Purpose To evaluate the usefulness of subtraction images for enhancing the visual detection of pituitary microadenomas. Material and Methods In total, 50 patients with clinically established diagnosis hyperprolactinemia, acromegaly, and Cushing's disease were enrolled. Ten patients referred for brain MRI for reasons other than pituitary abnormality were selected as control group. Routine dynamic MRI of the pituitary gland and obtained subtraction MRI scans were scrutinized separately on different sessions by an experienced radiologist blinded to the study design and patient's data. The investigator's opinion on the presence or absence of a lesion and lesion size were collected. Results In patients with pituitary microadenoma, dynamic MRI images were reported positive in 42 (84%) patients and negative in 8 (16%). Subtraction images were described as positive in all patients (100%)—including all patients with negative dynamic MRI—and the difference was statistically significant ( P=0.016). Undetected lesions on dynamic MRI had a mean size of 2.84 ± 1.79 mm (median= 2.20 mm, interquartile range=1.62–4.62 mm) and a significant inverse correlation was noted between lesion size and negative report of dynamic MRI ( P=0.018). Brain MRI scans in the control group were reported negative for pituitary microadenoma in both dynamic contrast-enhanced and subtraction images. Conclusion Subtraction images can successfully identify all lesions detectable with conventional dynamic MRI as well as improving visualization of lesions undetected on dynamic MRI, especially in small lesions.
Objective
To investigate the attitudes of radiologists toward palpable breast masses with benign features on US and to determine the factors influencing their decision.
Methods
A 20-question online questionnaire was sent to radiologists with membership of the Iranian Society of Radiology and included questions regarding demographics, practice experience, and management approach to palpable circumscribed breast masses based on patient age and risk factors. Radiologists’ management choice for masses in themselves or close relatives/friends was also queried.
Results
In total, 151 radiologists participated (response rate 16%). For palpable breast masses with benign imaging features in women at high risk, the majority of radiologists selected MRI (95/151, 62.9%) and core-needle biopsy (110/151, 72.8%). In average-risk patients, radiologists with >5 years of practice experience selected biopsy more frequently (33/79, 41.8%) than less experienced radiologists (17/79, 23.6%) for patients ≥40 years old (P < 0.001) and patients <40 years old (20/79, 25.3%; 11/72, 15.3%, respectively) (P = 0.014). Similarly, selecting biopsy was more common in radiologists who completed a breast imaging fellowship for patients ≥40 years old (23/45, 51.1% vs 27/106, 25.5%) (P = 0.04), as well as for patients <40 years old (18/45, 40% vs 13/106, 12.3%) (P = 0.02). Radiologists who were <40 years old selected biopsy more frequently if evaluating a mass in themselves (22/86, 25.6%) compared to patients (15/86, 17.4%) (P < 0.001).
Conclusion
Radiologist experience and educational background, as well as patient baseline breast cancer risk, can predispose radiologists to choose biopsy for palpable breast masses despite a benign appearance on imaging.
Pseudoxanthoma elasticum (PXE) is a hereditary disorder that affects primarily the elastic tissues of skin, eyes and blood vessels. Its estimated prevalence is thought to be 1:25,000 -100,000. PXE patients also carry an increased risk for cardiovascular and gastrointestinal diseases. Early diagnosis can play a crucial role in preventing early loss of vision and systemic complications in these patients however despite having characteristic clinical features; it is still to a large extent being under-diagnosed. Here we present two cases of PXE with reduced vision.
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