Scientific Session 1 â Breast Imaging: Mammography

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Scientific Session 22—Musculoskeletal Imaging: Technical DevelopmentsThursdayMaterials and Methods: A prospective institutional review board–approvedand HIPAA-compliant study was performed by recruiting normal subjects,patients with a history of chronic partial ACL tears, and patients with andreconstructed ligaments. Subjects were scanned on a 1.5-T dedicated extremitymagnet with an inflatable device placed proximal and distal to the knee toachieve progressive anterior translation of the tibia with respect to the femurduring incremental graded pressure increases. Patients were imaged withsagittal T1-weighted non–fat-saturated sequences with application of successivepressures of 0, 40, 80, 120, and 160 psi. The anterior drawer of thetibia was measured from the posterior aspect of the lateral femoral condyle.Degrees of flexion and extension at the knee joint were also measured.Results: Twelve patients were recruited: four normal asymptomatic patients,four with chronic ACL partial tears, and four with ACL reconstructions.Seven patients were female and eight male, with a mean age of25.2 years. Five right knees and seven left knees were studied. On staticimaging (0 psi), the mean anterior drawer measurement in the normal,chronic partial tear, and reconstruction groups was 3.4 mm, 4.6 mm, and5.2 mm, respectively. The maximum anterior drawer above this baselineafter the device was inflated in each group was a further 1.7 mm, 0.9mm, and 2.7 mm, respectively. Mean maximum knee joint hyperextensionduring inflation was measured as 1º, 15º and 7º for normal, chronicpartial tear, and reconstruction groups respectively.Conclusion: Dynamic assessment of anterior drawer of the ACL is feasibleusing our described technique. Preliminary results suggest that ACLreconstructions demonstrate the most anterior drawer and chronic partialtears the most hyperextension compared with normal subjects during dynamicimaging. Further work is required to investigate these findings ina larger study group.191. Role of Dynamic Gadolinium-Enhanced MRI in Patients atRisk of Avascular Necrosis of the FemurKaur, N.*; Singh, P.; Giragani, S.; Sen, R.; Mittal, B.; Khandelwal, N.PGIMER, Chandigarh, IndiaAddress correspondence to N. Kaur (neerajkaur99@gmail.com)Objective: To evaluate the role of dynamic gadolinium-enhanced MRI in predictingthe presence or development of avascular necrosis (AVN) of the femur.Materials and Methods: This was a prospective study conducted at a tertiarycare teaching hospital with clearance from the ethics committee.Written informed consent was obtained in all cases. Twenty-two patients,aged 13–60 years, at risk of AVN of the femur were followed with serialinvestigations (radiographs, MRI, and nuclear scan) at 6, 12, and 24weeks. MRI was done on a 1.5-T unit with body phased-array coil usingdynamic sequences (T1-weighted FLASH sequence after IV gadolinium),at 6 weeks and conventional nonenhanced sequences (T1-weightedcoronal, T1-weighted axial, T2-weighted axial, inversion recovery coronaland sagittal T1-weighted images), at 6, 12, and 24 weeks. Analysisof dynamic MR images was done by native review and region of interestmethod. Correlation of vascularity and enhancement on dynamic MR imageswith presence or future development of AVN was found.Results: Nine patients were diagnosed with AVN. Dynamic MRI showeda hypovascular pattern in three patients (14%) who all had or subsequentlydeveloped AVN. Hypovascularity on dynamic MRI and AVNpresence or development had positive correlation (r = 0.478, p = 0.03).Hypoenhancing areas were observed in six patients on contrast-enhancedMRI. All had or developed AVN. Presence of hypoenhancement andAVN presence or development also had positive correlation (r = 0.74, p< 0.001). Contrast-enhanced MR images significantly added to the diagnosticconfidence by sharp delineation of avascular foci (hypoenhancingareas) from adjacent viable areas (normally enhancing areas).Conclusion: Hypovascularity or hypoenhancement on dynamic MRI at6 weeks helps in predicting presence or future development of AVN.Patients with these MRI findings require closer follow-up for early detectionof AVN and timely intervention for salvaging the hips.192. Feasibility Analysis With Existing Quantification Methods forMRI-Based Necrosis Volume Estimation in Treated Soft-TissueSarcomas: Analysis Based on Tumor Size, Grade, and TissueCharacteristicsKurra, V. 1,2 *; Singh, A. 2 ; Chen, Y. 2 ; Cai, W. 2 ; Choy, E. 2 ; Harmon, D. 2 ;McGowan, J. 2 ; Harris, G. 2 1. Brigham and Womens Hospital, Boston,MA; 2. Massachussetts General Hospital, Boston, MAAddress correspondence to V. Kurra (vkurra@partners.org)Objective: To study the feasibility and accuracy of existing manual andsemiautomated tools for necrosis quantification in treated soft-tissue sarcomaswith varied size and appearance.Materials and Methods: In this ongoing retrospective study, gadoliniumenhancedT1-weighted fat-saturated images from MRI datasets of 39patients treated for pathologically proven soft-tissue sarcomas with chemotherapy(n = 9/39), radiation (n = 7/39), and both (n = 23/39) wereretrieved from the database. MRI was obtained within 1–15 days prior tosurgical excision. Semiautomated mapping for estimation of necrotic andtotal tumor volume was performed by a radiologist using a thresholdingtool and a blow-up tool on a 3D workstation, respectively, on the samecontrast-enhanced T1-weighted sequence, and unenhanced enhancingtumor percentage was derived. Postexcision partial-tissue stained pathologypercentage estimate for nonviable tissue was taken as standard ofreference for percentage of nonenhancing tumor volumes obtained byMRI quantification and compared using correlation and Bland-Altmananalysis. The time for performing segmentations was studied based ontumor grades on pathology, tumor size, and tissue characteristics, and apaired Student t test was used for comparison of variables.Results: In the majority of the cases (37/39 cases), the necrotic volumepercentage derived from MRI volumetry was within 1.96 SD (–82.0 to115.7) of the Bland-Altman plot with excellent correlation (r = 0.8852; p< 0.0001; 95% CI = 0.7905–0.9386). Average time taken for performingsegmentation and percentage volume generations was 13.517 minutes. Thetime taken for quantification in tumors less than 5 cm in diameter was significantlyless than time taken in tumor greater than 5 cm in diameter (< 5cm = 7.331 min; > 5 cm = 12.813 min; p = 0.0435). The average time forperforming segmentations in low grade (10.684 min) and myxolipomatoustumors (8.688 min) was less than high grade (13.666 min) and nonmyxolipoidtumors (13.224 min), respectively, but statistical significance was notachieved (tumor grading, p = 0.1032; tumor tissue, p = 0.4578).Conclusion: With the use of existing semiautomated 3D segmentation techniquesbased on thresholding and region-grow principles, tumor size was theA72*Will present paper
ThursdayScientific Session 22—Musculoskeletal Imaging: Technical Developmentsonly significant determinant for time savings for MRI-based quantificationof necrosis in soft-tissue sarcomas in this study. Tumor grading and tumortissue characteristics did not contribute significantly to time savings.193. Image-Guided Bone Biopsy: Accuracy, Safety, and Correlationwith FDG PET ImagingCullen, E.*; Welch, T. Mayo Clinic, Rochester, MNAddress correspondence to E. Nelson (nelson.ethany@mayo.edu)Objective: CT-guided bone biopsies and PET scans are often a part ofthe workup of bone lesions. This retrospective review was conducted todetermine the safety and accuracy of image-guided bone biopsy, and theutility of PET scans to evaluate bone lesions.Materials and Methods: This was an institutional review board–approvedstudy of 103 patients who had CT-guided bone biopsies and FDGPET scans from 2004 to 2008. All clinical, imaging, and procedural datawere reviewed. The data reviewed included lesion characteristics, tissuesample size, biopsy pathology, biopsy technique, possible biopsy complications,surgical pathology, and clinical course. PET data reviewedincluded PET standardized uptake values (SUVs). The data were thenanalyzed to determine the accuracy and complication rate of CT-guidedbone biopsy. The data were reviewed with respect to amount of tissueobtained and lesion location to determine if there was a threshold tissuevolume level or an anatomic location that was more likely to yielddiagnostic results. PET scan data were reviewed for lesion detection andbiopsy planning and compared with pathology results to assess any correlationbetween SUV and final pathology.Results: The accuracy rate for image-guided bone biopsy was 94% withno false-positive results. There were no complications related to biopsy.No correlation was found between tissue sample size or lesion locationand pathology results. In examining the PET SUV data, lesions with benignpathology had maximum SUV ranging from 2 to 7.4 and malignantlesions ranged from a maximum SUV of 2 to 25.3. The PET scan washelpful in lesion detection and biopsy planning.Conclusion: CT-guided bone biopsy is a safe and accurate procedure.There were no complications in this series and no correlation was foundbetween pathology results and tissue sample size. The PET SUV for benignand malignant pathology had considerable overlap, but maximumSUV greater than 8 likely indicates malignant pathology. The PET scanwas of value in lesion detection and biopsy planning.194. Comparison of Sonography and Physical Examinationin Evaluating Disease Activity in Children With JuvenileInflammatory ArthritisPanghaal, V.*; Janow, G.; Levin, T.; Wahezi, D.; Badger, D.; Ilowite, N.Montefiore Medical Center, Albert Einstein College of Medicine, NorthBergen, NJAddress correspondence to V. Panghaal (vickpanghaal@hotmail.com)Objective: Juvenile inflammatory arthritis (JIA) is a potentially debilitatingdisease of childhood with significant physical, psychological, andfinancial costs. Early identification and treatment of active arthritis mayprevent long-term joint damage and disability. Power Doppler sonographyhas been shown to aid in assessing joint activity and detecting subclinicaldisease. The purpose of our study was to compare power Dopplersonography with physical examination in evaluating disease activity inthe knees and ankles in children with JIA.Materials and Methods: Ultrasound of the knees and ankles in childrenwith known JIA was performed and compared with ultrasound.Institutional review board approval was obtained. In each patient, a longitudinalmidline image of both distal femurs, a coronal image of themedial and lateral femorotibial joint, and a longitudinal midline imageof both tibiotalar joints on conventional and power Doppler sonographywere obtained (12-MHz linear transducer). Images were reviewed by twoboard-certified radiologists in consensus, blinded to the clinical examination.Active arthritis was defined as synovial thickening, joint effusion,or increased vascularity on power Doppler sonography. Vascularity wasquantified as none, mild (one or two color pixels), and moderate/severe(more than two color pixels). Active arthritis on physical examinationwas defined as non-bony swelling, demonstrable effusion, or limitationof motion with either pain on motion or tenderness.Results: Eighty-four joints in 21 patients were evaluated. Of these, 65joints were concordant on both ultrasound and physical examination (31active, 34 inactive). Of the remaining 19 joints, 14 were active on ultrasoundand inactive on physical examination while five were inactive onultrasound and active on physical examination. Of the joints that wereactive on ultrasound and inactive on physical examination, five had subclinicaldisease and subsequently developed clinically evident disease on2-month follow-up, one was lost to follow-up, and eight had only mildincreased vascularity on ultrasound. Of the joints that were inactive onultrasound and active on physical examination, four had subtalar involvementand one had no explanation.Conclusion: Ultrasound is effective in detecting disease activity in childrenwith JIA and is complementary to physical examination. In clinicallyactive patients in whom ultrasound is negative, subtalar diseaseshould be considered. Ultrasound may detect early disease not evident onphysical examination. Mild increased joint vascularity is not specific andmay not correlate with disease activity.195. Cost Utility Analysis of Ultrasound Alone, MRI Alone, andUltrasound Plus Preoperative MRI for the Evaluation of RotatorCuff TearsSuber, R. 1 *; Mather, R. 2 ; Orlando, L. 1 1. Duke University, Durham, NC;2. Rush University Medical Center, Chicago, ILAddress correspondence to R. Suber, Jr. (lee.suber@duke.edu)Objective: MRI remains the more common imaging modality to evaluatethe rotator cuff even though ultrasound has been proposed as a morecost-effective strategy. Our purpose was to perform a cost utility analysisincluding a hybrid imaging strategy whereby ultrasound is utilized as theinitial imaging test for rotator cuff tear, followed by preoperative MRI toprovide anatomic imaging and the possibility of identifying alternativeand concurrent diagnoses.Materials and Methods: A decision model of the evaluation and treatmentof rotator cuff tears was constructed utilizing TreeAge Pro (TreeAgeSoftware). Three strategies were evaluated: ultrasound alone, MRI alone,*Will present paperA73
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Scientific Session 1 â Breast Imaging: Mammography