Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013in 12 (48%), hyperechoic in 1 (4%), and mixed echogenicity in 9 (36%).Four of the 25 masses demonstrated posterior acoustic enhancement(16%), and 21 of the 25 masses did not demonstrate posterior acoustic enhancement(84%). Doppler vascularity was present in 11 patients (44%).A mass was demonstrated in 19 patients; 5 masses were well defined(26%), and 15 masses had irregular margins (74%). Twenty-six of the 27patients had correlative mammographic findings. Pathologic diagnosiswas made by US-guided biopsy in 11 of 27 (40%), US-guided fine- needleaspiration in 1 of 27 (4%), and mammotome biopsy in 1 of 27 (4%).Palpation-guided tissue sampling was performed in 12 of 27 (44%). Surgicalexcision was performed in 7 of 27 (26%).Conclusions—The sonographic features of GM are infrequentlydescribed. Our study demonstrated that the sonographic findingsare indeterminate and may mimic malignancy. Although previously reportedexclusively in young women with palpable findings, our studydemonstrates that it can occur in postmenopausal as well as asymptomaticpatients. The diagnosis of GM is optimally made by US-guided corebiopsy.1538026 Using a New Ultrasound Image-Processing Technique forIdentification of Microcalcifications in Patients Prior toBiopsyPriscilla Machado,* John Eisenbrey, Barbara Cavanaugh,Flemming Forsberg Radiology, Thomas Jefferson University,Philadelphia, Pennsylvania USAObjectives—To evaluate a new commercial image-processingtechnique (MicroPure; Toshiba America Medical Systems, Tustin, CA)for the identification of breast microcalcifications in patients undergoingstereotactic or ultrasound (US)-guided biopsies and to compare results tox-ray imaging of the tissue retrieved.Methods—Twelve women, scheduled for stereotactic biopsyor US-guided biopsy of an area with breast calcifications (identified on aprior mammogram), were enrolled in the study. The patients underwent aUS examination consisting of real-time dual imaging of grayscale US andMicroPure using an Aplio XG scanner (Toshiba America Medical Systems)with a broad-bandwidth linear array. MicroPure combines nonlinearimaging and speckle suppression to mark suspected calcifications aswhite spots in a blue overlay image. Still images and digital clips of thetarget area were acquired. Independent and blinded readers (2 radiologistsand 2 physicists) analyzed 26 digital clips to determine the number of calcificationsseen with MicroPure and also to give a subjective view on thelevel of suspicion (LOS) of the findings. X-ray imaging of the specimenwas analyzed by a radiologist who counted the exact number of microcalcifications.The number of microcalcifications was compared using themean number from the 4 readers with the mean number on the x-rayimage. The LOS was compared with the pathologic findings using receiveroperating characteristic (ROC) analysis.Results—The mean number of microcalcifications seen onMicroPure was 6.96 (3.33–13.37). These values show excellent agreementwith the mean number of microcalcifications seem on the x-rayimage of the tissue retrieved (7.42; P = .39). ROC analysis of the readers’LOS scores compared to the pathologic findings produced areas under thecurve of 0.74–0.99.Conclusions—MicroPure imaging was able to identify microcalcificationsat the target area as confirmed by x-ray imaging of the tissuespecimen. These findings indicate that MicroPure may be used toguide breast biopsy procedures, but more studies are needed.1540975 The Natural History of Thyroid Nodules With PeripheralCalcificationArash Anvari,* Anthony Samir Radiology, AbdominalImaging and Intervention, Massachusetts General Hospital,Boston, Massachusetts USAObjectives—Peripheral dystrophic calcification is a known patternin thyroid nodules seen on ultrasound (US) and can be found in bothbenign and malignant nodules. The American Thyroid Association (ATA)guidelines for recommending biopsy in the setting of nodule follow-upare predicated on a change in nodule size exceeding 50%. It is unknownwhether rim calcification in a thyroid nodule may prevent nodule enlargement,potentially rendering the ATA biopsy criteria ineffective. Theobjective of this study was to determine whether rim calcified nodules undergoingUS follow-up are able to enlarge to an extent meeting ATA criteriafor fine-needle aspiration biopsy (FNAB).Methods—We searched our institute’s radiology report databasefor thyroid nodules with rim calcification between 2002 and 2011. Wethen reviewed each subject to determine parameters like demographicdata, nodule size, timing and number of follow-up sonograms, and FNABand/or surgical pathologic results. We calculated nodule volumes usingthe formula for a rotational ellipsoid (volume = depth × width × length ×π/6) to evaluate the growth rate between the first and last US reports.Results—We found 197 thyroid nodules with peripheral rimcalcification in 192 subjects; 164 subjects (85.4%) were female (age range,30–90 years; 60.35 ± 13.77 years; maximal dimension range, 3–36 mm;11.95 ± 7.12 mm). We evaluated volume changes in 59 nodules that hada US follow-up interval of at least 1 year (range, 1–9.5 years; 3.58 ± 2.14years). Thyroid nodule volumes ranged from 0.02 to 14.19 mL (1.04 ±2.29 mL) at the initial follow-up and ranged from 0.02 to 10.75 mL (11 ±2.06 mL) at the last follow-up. Over the period of follow-up, 17 of 59 rimcalcified nodules (28.9%; 95% confidence interval, 17.3%–40.4%)changed in volume by >50%. The proportion of nodules with volumechanges exceeding 50% increased with longer follow-up and when themaximal diameter was