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Fakhry S, Kamal RM, Tohamey YM, Kamal EF. Unilateral primary breast edema: Can T2-weighted images meet the diagnostic challenge? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Unilateral primary breast edema may pose a diagnostic challenge. Excluding malignant etiologies is of utmost importance and may require the use of dynamic MRI examination as a problem solver. Yet, the enhancement pattern of benign and malignant disorders associated with edematous breasts may overlap, and this may add to the dilemma. So, our aim in the current study was to assess the role of T2-weighted MR imaging as a problem-solving sequence in differentiating benign from malignant causes of the edematous breast.
Results
In the current prospective study, 65/96 cases were benign and 31/96 cases were malignant. By the individual analysis of the signal intensity in T2-weighted imaging of MRI examination, there was a significant correlation between low T2 signal intensity lesion and malignant etiology of breast edema with a resultant higher sensitivity of 83.87% and a higher specificity of 98.46% as compared to the contrast-enhanced series, which achieved a sensitivity of 80.65% and a specificity of 20.00%. The combined assessment of T2 WI and the contrast-enhanced series yielded a higher sensitivity of 100% and a specificity of 98.46%.
Conclusions
T2WI is a problem-solving sequence in the evaluation of the primary edematous breast, yielding a significant added value in the diagnostic approach and improving the overall diagnostic performance of dynamic contrast-enhanced MRI.
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2
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Park JY, Yi SY. Case reports of shear-wave elastography (SWE) features of lymphoma involving the breast. Radiol Case Rep 2021; 17:641-646. [PMID: 35027988 PMCID: PMC8715132 DOI: 10.1016/j.radcr.2021.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/26/2022] Open
Abstract
Breast lymphoma is a rare malignancy that is often difficult to distinguish from other breast diseases. Elastography has been proven to facilitate the diagnosis of breast lesions. However, only few reports have focused on the elastographic features of breast lymphoma. Therefore, we herein present 2 cases of breast lymphomas with a focus on the elastographic findings.
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Affiliation(s)
- Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
- Corresponding author.
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3
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Systemic diseases affecting the breast: Imaging, diagnosis, and management. Clin Imaging 2021; 77:76-85. [PMID: 33652268 DOI: 10.1016/j.clinimag.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.
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4
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Gluskin J, D'Alessio D, Kim AC, Morris EA, Chiu A, Noy A. Primary lymphoma of the breast: A report of two cases. Clin Imaging 2020; 68:295-299. [PMID: 32961512 DOI: 10.1016/j.clinimag.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022]
Abstract
Primary breast lymphoma (PBL) should be distinguished from secondary breast lymphoma arising in the setting of lymphoma elsewhere in the body. Multimodality imaging is key to diagnosing PBL, and imaging manifestations thereof may indicate PBL and alter the treatment course. Treatment options including chemotherapy, radiation therapy, and/or surgery depend on histology. We report two cases of PBL, illustrating the transformative impact that multimodality imaging may have on clinical management.
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Affiliation(s)
- Jill Gluskin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Donna D'Alessio
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew C Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - April Chiu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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5
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Abstract
This retrospective study aimed to improve the diagnostic accuracy of breast lymphoma (BL) by analyzing the findings of BL on mammography and magnetic resonance imaging (MRI).Fifteen patients with breast lymphoma (BL, Primary/Secondary: 13/2) were confirmed by pathology. The imaging findings of those patients were analyzed by 2 senior radiologists.BL commonly showed significant enhancement with penetrating vessels and septation in masses on dynamic contrast-enhanced MRI (DCE-MRI). Diffusion limitation of BL is more pronounced than breast cancer on diffusion weighted imaging.The study suggests that the penetrating vessels and diffusion restriction of lesions are helpful for the diagnosis and differential diagnosis of BL.
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Affiliation(s)
- Changyu Zhou
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University
| | - Kun Lv
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dongya Lin
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University
| | - Yinxing Yu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University
| | - Yangyang Bu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University
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6
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Wienbeck S, Meyer HJ, Surov A. [Imaging findings of intramammary malignant lymphoproliferative disease]. Radiologe 2018; 58:929-934. [PMID: 29992401 DOI: 10.1007/s00117-018-0428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Intramammary manifestation of lymphoproliferative disease is rare. The radiological evaluation follows in most cases the clinical suspicion and therefore the radiologist takes an important place in diagnostics. The aim of this work is to demonstrate typical radiological patterns of this rare entity with multimodal cases and to sensitize for it. The differential diagnosis to other breast tumors, especially primary breast carcinoma, can be radiologically difficult, so the suspicious lesion must be histologically verified by biopsy.
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Affiliation(s)
- S Wienbeck
- Institut für Diagnostische und Interventionelle Radiologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - H J Meyer
- Institut für Diagnostische und Interventionelle Radiologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Surov
- Institut für Diagnostische und Interventionelle Radiologie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.,Institut für Radiologie, Universität Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
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7
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Aslan H, Pourbagher A. Breast Involvement by Hematologic Malignancies: Ultrasound and Elastography Findings with Clinical Outcomes. J Clin Imaging Sci 2017; 7:42. [PMID: 29296470 PMCID: PMC5747218 DOI: 10.4103/jcis.jcis_65_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022] Open
Abstract
Objective: Hematological malignancies very rarely involve the breast. The aim of this study is to retrospectively evaluate B-mode ultrasound (US) and elastography (ES) findings of breast involvement by hematologic malignancies with clinical outcomes. Materials and Methods: All core-needle biopsy results that were performed at our tertiary breast center from January 2013 to September 2016 were searched. Our search revealed 9 patients with breast involvement either by leukemia or lymphoma. All patients were examined using B-mode US and ES. US and ES findings were analyzed with the consensus of two radiologists, and clinical outcomes were noted. Results: The mean age of the study population was 41.6 years (range, 20–83 years). Two patients showed diffuse hypoechoic parenchymal infiltration. The elasticity assessments of these lesions were soft and intermediate. The remaining 7 patients had mass lesions. The elasticity assessment of these masses according to Breast Imaging Reporting and Data System US was as follows: Soft (n = 1), intermediate (n = 4), high (n = 2). Conclusions: It is important to consider that hematologic malignancies may appear as soft or intermediate lesions on ES. Patients’ history and clinical background should help us to consider breast involvement. In addition, the clinical outcomes may not be related with elasticity assessments.
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Affiliation(s)
- Hulya Aslan
- Department of Radiology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Dadaloglu Mh, Adana, Turkey
| | - Aysin Pourbagher
- Department of Radiology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Dadaloglu Mh, Adana, Turkey
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8
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Wienbeck S, Meyer HJ, Uhlig J, Herzog A, Nemat S, Teifke A, Heindel W, Schäfer F, Kinner S, Surov A. Radiological imaging characteristics of intramammary hematological malignancies: results from a german multicenter study. Sci Rep 2017; 7:7435. [PMID: 28785116 PMCID: PMC5547097 DOI: 10.1038/s41598-017-07409-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/23/2017] [Indexed: 11/09/2022] Open
Abstract
To assess radiological procedures and imaging characteristics in patients with intramammary hematological malignancies (IHM). Radiological imaging studies of histopathological proven IHM cases from ten German University affiliated breast imaging centers from 1997-2012 were retrospectively evaluated. Imaging modalities included ultrasound (US), mammography and magnetic resonance imaging (MRI). Two radiologists blinded to the histopathological diagnoses independently assessed all imaging studies. Imaging studies of 101 patients with 204 intramammary lesions were included. Most patients were women (95%) with a median age of 64 years. IHM were classified as Non Hodgkin lymphoma (77.2%), plasmacytoma (11.9%), leukemia (9.9%), and Hodgkin lymphoma (1%). The mean lesion size was 15.8 ± 10.1 mm. Most IHM presented in mammography as lesions with comparable density to the surrounding tissue, and a round or irregular shape with indistinct margins. On US, most lesions were of irregular shape with complex echo pattern and indistinct margins. MRI shows lesions with irregular or spiculated margins and miscellaneous enhancement patterns. Using US or MRI, IHM were more frequently classified as BI-RADS 4 or 5 than using mammography (96.2% and 89.3% versus 75.3%). IHM can present with miscellaneous radiological patterns. Sensitivity for detection of IHM lesions was higher in US and MRI than in mammography.
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Affiliation(s)
- Susanne Wienbeck
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Hans Jonas Meyer
- University Hospital Halle, Department of Radiology, Ernst-Grube-Str. 40, 06120, Halle, Germany
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Aimee Herzog
- University of Jena, Institute for Diagnostic and Interventional Radiology, Erlanger Allee 101, 07747, Jena, Germany
| | - Sogand Nemat
- University of Saarland, Institute for Diagnostic and Interventional Radiology, Kirrberger Str. 100, 66424, Homburg, Germany
| | - Andrea Teifke
- University of Mainz, Department of Diagnostic and Interventional Radiology, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Walter Heindel
- University of Muenster, Institute for Clinical Radiology, Albert-Schweitzer-Str. 33, 48149, Muenster, Germany
| | - Fritz Schäfer
- University of Kiel, Institute for Radiology and Neuroradiology, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Sonja Kinner
- University of Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Hufelandstr. 55, 45147, Essen, Germany
| | - Alexey Surov
- University Hospital Halle, Department of Radiology, Ernst-Grube-Str. 40, 06120, Halle, Germany.,University of Leipzig, Department of Diagnostic and Interventional Radiology, Liebigstr. 20, 04103, Leipzig, Germany
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9
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Bitencourt AGV, Gama RRM, Graziano L, Negrão EMS, Sabino SMPS, Watanabe AHU, Guatelli CS, Souza JA, Mauad EC, Marques EF. Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol 2017; 90:20170197. [PMID: 28485985 DOI: 10.1259/bjr.20170197] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast metastases from extramammary cancers are rare and usually related to poor prognosis. The extramammary tumours most frequently exhibiting breast metastases are melanoma, lymphomas, ovarian cancer, lung and neuroendocrine tumours, and sarcomas. Owing to the lack of reliable and specific clinical or radiological signs for the diagnosis of breast metastases, a combination of techniques is needed to differentiate these lesions from primary breast carcinoma or even benign breast lesions. Multiple imaging methods may be used to evaluate these patients, including mammography, ultrasound, MRI, CT and positron emission tomography CT. Clinical and imaging manifestations are varied, depend on the form of dissemination of the disease and may mimic primary benign and malignant breast lesions. Haematologically disseminated metastases often develop as a circumscribed mass, whereas lymphatic dissemination often presents as diffuse breast oedema and skin thickening. Unlike primary carcinomas, breast metastases generally do not have spiculated margins, skin or nipple retraction. Microlobulated or indistinct margins may be present in some cases. Although calcifications are not frequently present in metastatic lesions, they occur more commonly in patients with ovarian cancer. Although rare, secondary malignant neoplasms should be considered in the differential diagnosis of breast lesions, in the appropriate clinical setting. Knowledge of the most common imaging features can help to provide the correct diagnosis and adequate therapeutic planning.
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Affiliation(s)
| | - Roberta R M Gama
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luciana Graziano
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Erika M S Negrão
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Silvia M P S Sabino
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Anapaula H U Watanabe
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Camila S Guatelli
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Juliana A Souza
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Edmundo C Mauad
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Elvira F Marques
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
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10
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Wang L, Wang D, Chai W, Fei X, Luo R, Li X. MRI features of breast lymphoma: preliminary experience in seven cases. Diagn Interv Radiol 2016; 21:441-7. [PMID: 26380896 DOI: 10.5152/dir.2015.14534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the imaging features of breast lymphoma using magnetic resonance imaging (MRI). METHODS This retrospective study consisted of seven patients with pathologically confirmed breast lymphoma. The breast lymphomas were primary in six patients and secondary in one patient. All patients underwent preoperative dynamic contrast-enhanced MRI and one underwent additional diffusion-weighted imaging (DWI) with a b value of 600 s/mm2. Morphologic characteristics, enhancement features, and apparent diffusion coefficient (ADC) values were reviewed. RESULTS On MRI, three patients presented with a single mass, one with two masses, two with multiple masses, and one with a single mass and a contralateral focal enhancement. The MRI features of the eight biopsied masses in seven patients were analyzed. On MRI, the margins were irregular in six masses (75%) and spiculated in two (25%). Seven masses (87.5%) displayed homogeneous internal enhancement, while one (12.5%) showed rim enhancement. Seven masses (87.5%) showed a washout pattern and one (12.5%) showed a plateau pattern. The penetrating vessel sign was found in two masses (25%). One patient with two masses underwent DWI. Both masses showed hyperintense signal on DWI with ADC values of 0.867×10-3 mm2/s and 0.732×10-3 mm2/s, respectively. CONCLUSION Breast lymphoma commonly presents as a homogeneously enhancing mass with irregular margins and displays a washout curve pattern on dynamic MRI. A low ADC value may also indicate a possible diagnosis of breast lymphoma.
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Affiliation(s)
- Lijun Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Kalli S, Lanfranchi M, Alexander A, Makim S, Freer PE. Spectrum of Extramammary Malignant Neoplasms in the Breast With Radiologic-Pathologic Correlation. Curr Probl Diagn Radiol 2015; 45:392-401. [PMID: 26416136 DOI: 10.1067/j.cpradiol.2015.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 01/07/2023]
Abstract
Although primary breast cancer is the most common malignancy identified by breast imaging, extramammary malignancies may also rarely be encountered. These uncommon lesions may reflect primary neoplasms of nonmammary origin as well as secondary metastatic lesions, and include lymphoma, melanoma, neuroendocrine tumors, gastrointestinal tract malignancies, and angiosarcoma among other entities. Malignant extramammary breast lesions may be encountered during routine mammographic screening, identified during the diagnostic evaluation of a palpable breast abnormality, or may be detected incidentally during imaging of other organs of interest. As such, the radiologist should have familiarity with the appearance of these lesions. This article focuses on a review of several of the most common extramammary metastases to the breast, as well as a few lesions that may develop as either primary or secondary lesions.
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Affiliation(s)
- Sirishma Kalli
- Department of Radiology, Tufts Medical Center, Boston, MA.
| | | | | | - Shital Makim
- Department of Radiology, Tufts Medical Center, Boston, MA
| | - Phoebe E Freer
- Avon Comprehensive Breast Center, Massachusetts General Hospital, Boston, MA
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12
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Kong EJ, Cho IH. F-18 FDG PET/MRI findings of primary breast lymphoma in two cases: FDG PET/MRI findings of primary breast lymphoma. Clin Imaging 2015; 39:682-4. [PMID: 25748090 DOI: 10.1016/j.clinimag.2015.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Abstract
We present the integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) findings of diffuse large B-cell lymphoma involving the breast in two women. They were admitted with palpable breast masses. PET/MRI revealed high (18)F-fluorodeoxyglucose (FDG) uptake in multinodular enhancing masses without other FDG-avid foci. Diffusion-weighted imaging showed restricted water diffusion and dynamic contrast MRI showed rapid increase and washout kinetics. High FDG accumulation in tumor is related to washout kinetics. We present the usefulness of integrated PET/MRI for lesion characterization and total body staging in breast lymphoma.
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Affiliation(s)
- Eun Jung Kong
- Department of Nuclear Medicine, Yeungnam University, College of Medicine, Daegu, Republic of Korea.
| | - Ihn Ho Cho
- Department of Nuclear Medicine, Yeungnam University, College of Medicine, Daegu, Republic of Korea
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