Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSE

The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.

METHODS

This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses.

RESULTS

The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.

CONCLUSION

ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Patients characteristics in Behçet's Syndrome and their associations with major organ involvement: a single-centre experience of 2118 cases

Objectives: To evaluate the demographic and clinical characteristics of patients with Behçet's syndrome (BS), and to define their associations with the presence of major organ involvement (MOI).Method: Medical records of 2118 patients (964 males, 1154 females) were analysed retrospectively. MOI was defined as the presence of at least one of vascular, eye, nervous, or gastrointestinal system involvement. Univariable and multivariable binary and ordinal logistic regression analyses were applied to assess the factors that were potentially associated with MOI.Results: The mean ± sd age at diagnosis was 30.5 ± 9.4 years. Genital ulcer and joint involvement were more common in females (both p < 0.001), while MOI was more frequent in males (p < 0.001). Genital ulcer (p < 0.001) and vascular involvement (p = 0.006) were more common in patients with a younger age at diagnosis, while joint involvement was more common in older patients. A total of 1097 patients (51.8%) had at least one MOI, 322 (15.2%) at least two MOIs, and 48 (2.3%) at least three MOIs. Male gender, smoking history, and absence of genital ulcer were significantly associated with MOI in multivariable binary logistic regression. Multivariable ordinal regression analyses confirmed the association between MOI and male gender and smoking, but not the protective effect of genital ulcers. In both regression analyses, we found no significant effects of age, human leucocyte antigen-B51, skin involvement, or joint involvement on MOI.Conclusion: Male gender and positive smoking history have a significant influence on the presence of MOI in patients with BS.

Second Look Ultrasonography-Guided Breast Biopsy with Magnetic Resonance Imaging Confirmation by Intralesional Contrast Injection

Objective

This study aimed to introduce an alternative pre-biopsy confirmation technique that combines sonography-guided intra-lesional contrast injections and single non-enhanced magnetic resonance imaging (MRI) pulse sequence in order to identify sonographic correlates of incidentally detected breast MRI lesions which were occult on primary ultrasonography (USG) and mammography examination.

Materials and Methods

From May 2014 through May 2015, a total of 37 incidental breast lesions of 37 patients, which were detected by breast MRI, were evaluated with targeted second look ultrasound (SLUS). The suspected lesion on USG was marked with a gadolinium-based contrast agent under USG guidance. After a single non-enhanced T1 weighted control MR sequence, positively correlated lesions with initial MRI were sampled by USG guided core biopsy.

Results

Of the 37 lesions evaluated, 32 (86%) lesions showed a correlation between MRI and SLUS findings. On SLUS core biopsy, there were eight (25%) malignant and 11 (34.4%) high-risk lesions among these 32 cases with correlated MRI findings; while the remaining 13 (40.6%) cases had benign histopathology. Eleven (34.4%) of the SLUS-discovered lesions were focus, 11 (34.4%) were non-mass enhancements, and the remaining 10 (31.2%) were mass lesions. Of the five lesions (13.5%) that showed no correlations on MRI and SLUS examinations, four were non-mass enhancements and one was focus.

Conclusion

SLUS represents a method for identifying MRI-detected lesions and provides a bridge to ultrasound-guided biopsy for histopathological diagnosis. There is a need for confirmation of biopsies to avoid false negative results. We describe a cheap, safe, and easy-to-apply USG-guided pre-biopsy lesions marking method in order to ensure definite correlation.

Royal jelly protection on flunixin meglumine-induced spermiotoxicity and testicular degeneration in mice

Current study was designed to investigate the protective effects of royal jelly on Flunixin me- glumine (FM)-induced spermiotoxicity related to sperm concentration, abnormal spermatozoa count and histopathological changes in mice testis. The subjects were divided into five groups according to FM and/or royal jelly intake: Control group; group 1, FM alone (25 mg/kg, im); group 2, combination of FM (25 mg/kg, im) and royal jelly (200 mg/kg, oral); group 3, FM alone (50 mg/kg, im); and group 4, combination of FM (50 mg/kg, im) and royal jelly (200 mg/kg, oral). The animals were fed once daily for 15 days and they were sacrificed last day. Epididymal sperm concentration and abnormal spermatozoa count were noted. Testicular histological findings were evaluated. On purpose, organization of each animal was graded according to Johnsen's scoring to assess the spermatogenesis relying on seminiferous tubule cross-section scores. Comparing to controls, FM administration caused a decrease in sperm concentration (p⟨0.05), an increase in total abnormal spermatozoa rates (p⟨0.05) and more degenerative changes in testes in mice. Royal jelly supplementation ameliorated both sperm concentration and abnormal spermato- zoa (p⟨0.05) comparing to the control group. In conclusion, we suggested that royal jelly might have protective effects in the FM-induced reductions in epididymal sperm concentration and in- crease in abnormal spermatozoa rate.

Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass

Bayramoğlu Z, Yılmaz R, Demir AA, Ataizi-Çelikel Ç, Kombak FE, İkinci A, Yekeler E. Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass. Turk J Pediatr 2019; 61: 120-125. Visceral myopathy is a rare cause of intestinal obstruction characterized by intestinal dysmotility and constipation. Patients often present with recurrent abdominal pain, vomiting and abdominal distension. We report a rare case of visceral myopathy in a child presenting with intraabdominal mass. We aimed to describe ultrasound, computed tomography and magnetic resonance enterography findings of this rare disease that has not been demonstrated before. Differential diagnosis of mural thickening with distinguishable layers in addition to intestinal dilatation in the absence of mesenteric inflammation includes visceral myopathy.

Our 20-Year Institutional Experience with Surgical Approach for Breast Hamartomas

Objective

Hamartomas are rare, slowly-growing breast tumours. Clinical, radiological and histopathological examination together increase the diagnostic accuracy. To evaluate the clinicopathologic features of hamartomas and outline our clinical approach to hamartomas in our 20-year experience at our Breast Clinic.

Materials and Methods

Between 1995 and 2015, 24 cases were retrospectively analyzed with a diagnosis of breast hamartoma at our Breast Clinic followed by excisional biopsy. Data was obtained on patient demographics, clinical examination, radiological findings and histopathological subtypes.

Results

Of 1338 benign breast tumours excised from January 1995 to January 2015, 24 (1.8%) were identified as breast hamartoma. Median age of patients was 42 (range, 13-70), whereas the median tumour size was 5 cm (1-10 cm). On preoperative imaging, hamartoma was most commonly misdiagnosed as fibroadenoma. Pathological examination of the 24 biopsy specimens revealed 3 cases with pseudoangiomatous stromal hyperplasia, and another hamartoma associated with a radial scar within the centre of the lesion. Of those, one patient was diagnosed with malignant phylloides tumour in the same breast. At a median follow-up 58.4 months, none of the patients recurred or developed malignancy.

Conclusion

Hamartomas can often be missed by clinicians, due to its benign nature which is poorly understood. Despite their slow growth, hamartomas can reach large sizes and can cause breast asymmetry. Although it is rare, hamartoma can be seen along with malignancy, as it is formed from similar components of breast tissue. Therefore, careful diagnosis and appropriate management including surgery are required.

Ectopic intrathyroidal thymus in children: Prevalence, imaging findings and evolution

Erol OB, Şahin D, Bayramoğlu Z, Yılmaz R, Akpınar YE, Ünal ÖF, Yekeler E. Ectopic intrathyroidal thymus in children: Prevalence, imaging findings and evolution. Turk J Pediatr 2017; 59: 387-394. The aim of this study was to evaluate the ultrasound (US) features of intrathyroidal ectopic thymus (IET) and demonstrate the alterations after follow-up. This study included 36 lesions of 32 patients (mean age 95 ± 58 months) diagnosed with IET. The patients underwent follow-up US examination at least 22-months without a medication or surgical intervention. A total of 36 IETs with an incidence of 0.91% were detected among 3914 thyroid ultrasound (US) examinations. The mean of anteroposterior (ap), transverse (tr), and craniocaudal (cc) diameters in the initial US examinations were 3.1±1.19 mm, 4.89±1.86 mm, and 6.45±3.92 mm respectively. All of the lesions were well-demarcated, hypoechoic to the thyroid gland, and contained uniformly distributed punctate echogenic foci. Follow-up US examinations were performed after 684±85 days. The alterations between the initial and follow-up diameters for ap and cc direction were not statistically significant. However, a significant difference (p=0.007) was found for transverse diameters and the IETs were found to be smaller at follow-up US than in the initial US. Most of the IETs were located in the left lobe (64%), middle portion (83%), and extended to a border of thyroid gland (69%) and nonspherical in shape (89%). The descriptive findings of IETs are uniform distribution of punctate echogenic foci, absence of a rim, and the presence of vessels traversing through the lesion without parenchymal displacement. Given our findings, healthcare professionals should be aware of the diagnosis of IET. Patients with an IET could be safely managed with follow-up US and any surgical treatment would not be required.

Favorable Long-Term Outcome in Male Breast Cancer

Objective

Male breast cancer (MBC) is a rare type of cancer in the breast cancer series and in the male population. Data is usually extrapolated from female breast cancer (FBC) studies. We aim to study the clinicopathological characteristics and outcome of MBC patients at our institution and we aim to emphasize the differences compared with FBC.

Materials and Methods

Between January 1993 and April 2016, 56 male patients who were diagnosed as breast cancer and underwent surgical operation were retrospectively analyzed. Patients were evaluated for demographical characteristics, surgery type, clinicopathological characteristics, adjuvant and neoadjuvant treatments, follow-up time, overall survival (OS), disease free survival (DFS), and disease specific survival (DSS).

Results

The ratio of MBC among all breast cancers at our institution is 1%. The median age was 64 (34-85). Surgical procedures were modified radical mastectomy (MRM) in 41 patients (77%), simple mastectomy in 11 patients (21%), and lumpectomy in 1 patient (2%). Two patients were Stage 0 (4%), 7 were Stage 1 (13%), 12 were Stage 2 (22.6%), and 32 were Stage 3 (60.4%). Molecular subtypes of the invasive tumors were luminal A in 40 (80%), luminal B in 6 (12%), HER-2 type in 1 (2%), and basal-like in 3 (6%). Median follow-up time was 77 (3-287) months. 5-year and 10-year OS, DFS, and DSS rates were 80.7%, 96%, 95.6% and 71.6%, 81.9%, 91.7% respectively.

Conclusion

MBC presents different clinicopathological and prognostic factors when compared to FBC. Our survival rates are higher than the average presented in available literature. Because of the high rate of hormone receptor positivity, hormonal therapy is the mainstay for the treatment of estrogen receptor (ER)+ male breast cancer.

Improved False-Negative Rates with Intraoperative Identification of Clipped Nodes in Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy

BACKGROUND

Identification and resection of a clipped node was shown to decrease the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for patients presenting with initially node-positive breast cancer.

METHODS

Between March 2014 and March 2016, a prospective trial analyzed 98 patients with axilla-positive locally advanced breast cancer (T1-4, N1-3) to assess the feasibility and efficacy of placing clips into most suspicious biopsy-proven node. The study considered blue, radioisotope active, and suspiciously palpable nodes as sentinel lymph nodes (SLNs).

RESULTS

The SLN identification rate was 87.8%. The median age of the patients with an SLNB (n = 86) was 44 years (range 28-66 years). Of these patients, 77 (88.4%) had cT1-3 disease, and 10 (11.6%) had cT4 disease. The majority of the patients (n = 66, 76.7%) had cN1, whereas 21 patients (23.3%) had cN2 and cN3. A combined method was used for 37 patients (43%), whereas blue dye alone was used for the remaining patients (57%). The clipped node was the SLN in 70 patients (81.4%). For the patients with cN1 before NAC, the FNR was found to be 4.2% (1/24) when the clipped node was identified as an SLN. However, the FNR was estimated to be as high as 16.7% (1/6) for the patients with cN1 before NAC when the clipped node was found to be a non-SLN.

CONCLUSIONS

The study results also suggest that axillary dissection could be omitted for patients presenting initially with N1 disease and with a negative clipped node as the SLN after NAC due to the low FNR.

Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy

Background:

Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found.

Aims:

To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies.

Study Design:

Diagnostic accuracy study.

Methods:

Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery.

Results:

Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis.

Conclusion:

Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.

The usefulness of agent emission imaging - high mechanical index ultrasound mode in the diagnosis of urolithiasis: a prospective preliminary study

PURPOSE

We aimed to determine the feasibility and effectiveness of agent emission imaging - high mechanical index (AEI-High MI) mode ultrasonography (US) compared with gray-scale and color Doppler US, alone or in combination, for the diagnosis of urolithiasis with reference to unenhanced computed tomography (CT).

METHODS

This prospective study included 72 consecutive patients (40 males, 32 females; mean age, 45.9±14.7 years) referred by the department of urology for acute or elective symptoms of urolithiasis and confirmed to have urinary calculi on unenhanced abdominal CT, between January 2015 and June 2015. Gray-scale, color Doppler, and AEI-High MI US were performed by two radiologists to determine the effectiveness of these methods in the diagnosis of urinary stones and to compare them with the reference modality.

RESULTS

A total of 189 calculi were detected on CT examination. Gray-scale US had a sensitivity of 66.1% and positive predictive value (PPV) of 88.7% for detecting calculi, while twinkling artifact of color Doppler had a sensitivity of 70.4% and PPV of 94.3%. The scintillation artifact of AEI-High MI mode had a sensitivity of 75.1% and PPV of 95.9%. When all ultrasound-based modalities were combined, the sensitivity and PPV rose to 83.1% and 88.2%, respectively. When calculi were grouped according to their size ( < 5 mm, 5-10 mm, > 10 mm), AEI-High MI mode had a higher sensitivity (60%) compared with gray-scale (32.5%) and color Doppler (41.3%) for calculi < 5 mm.

CONCLUSION

AEI-High MI mode had a higher sensitivity compared with gray-scale and color Doppler for the detection of calculi smaller than 5 mm, but it did not make a significant contribution to detection of larger calculi. The combined use of gray-scale US with AEI-High MI mode could increase the detection rate of calculi smaller than 5 mm and provide a method for verification of suspected calculi on gray-scale US.

Encapsulated Papillary Carcinoma in A Man with Gynecomastia: Ultrasonography, Mammography and Magnetic Resonance Imaging Features with Pathologic Correlation

Male breast cancer is an uncommon disease that constitutes 1% of all breast cancers and encapsulated papillary carcinoma (EPC) is a rare subtype of malignant male diseases. Gynecomastia is the most common disease of the male breast. We report a 63-year-old male patient with EPC accompanied by gynecomastia that was diagnosed and treated at our breast center. Mammography showed an oval-shaped dense mass with circumscribed margins on the ground of nodular gynecomastia. On ultrasonographic exam, we saw a well-circumscribed complex mass with a solid component which was vascular on Doppler ultrasonography. Magnetic resonance imaging revealed a complex cystic mass containing solid components. Dynamic images showed enhancement of the cystic mass wall and mural components. Tumor stage was evaluated as T2N0. The lesion's histologic examination and immunohistochemical analysis by showing no myoepithelial layer revealed an encapsulated papillary carcinoma. To our knowledge, this is the first case report which describes MR imaging findings of male breast encapsulated papillary cancer.

MR Imaging Features of Tubular Carcinoma: Preliminary Experience in Twelve Masses

Objective

We retrospectively analyzed the magnetic resonance (MR) imaging features and diffusion-weighted imaging findings of the 12 masses of 10 patients with tubular carcinoma (TC), including mammography and sonography findings.

Materials and Methods

Mammographic, sonographic and magnetic resonance imaging features in 12 histopathologically confirmed masses diagnosed as TC of the breast within 10 patients were evaluated. Morphologic characteristics, enhancement features, apparent diffusion coefficient (ADC) values were reviewed.

Results

On mammography (n=5), TC appeared as high density masses with indistinct, spiculated or obscured margins. Sonographically, TC appeared as a hypoechoic appearance (n=12) with posterior acoustic shadowing in nine. On MR imaging, the margins of ten of twelve masses were irregular. Internal enhancement patterns were heterogeneous in 10 patients. Dynamic enhancement patterns illustrated plateau kinetics (n=8). On the T2-weighted images 4 masses were hypointense, and 8 were hyperintense; hypointense internal septation was found in seven of these. Tubular carcinoma appeared as hyperintense on diffusion-weighted imaging with ADC values of 0.85±0.16×10-3 mm²/s that was lower than the normal parenchyma of 1.25±0.25×10-3 mm²/s.

Conclusion

According to our study with a limited number of cases, tubular carcinomas can be described as hyperintense breast carcinomas with or without dark internal septation like appearance on T2-weighted images. Low ADC values from DW imaging can be used to differentiate TC from hyperintense benign breast lesions.

Sonography and Magnetic Resonance Imaging Characteristics of Testicular Adrenal Rest Tumors

BACKGROUND

The aim of this study was to describe the gray-scale and color Doppler ultrasonography (US) and magnetic resonance (MR) imaging features of testicular adrenal rest tumors (TART) in patients with congenital adrenal hyperplasia.

MATERIAL/METHODS

Forty-one patients with congenital adrenal hyperplasia were evaluated by gray-scale and color Doppler ultrasonography. Totally eighteen adrenal rest tumors in 9 patients were diagnosed TART on US and MR imaging. Gray-scale and color Doppler US and MR findings of the patients were documented.

RESULTS

A total of eighteen masses were evaluated in nine patients. The mean age of these patients was 14.3±4.5 (range 10.1-23.3) years. US revealed hypoechoic lesions around the mediastinum testis with hypervascularity dispersing in ten patients and hypovascularity in two patients. In six patients, the lesions were hyperechoic with poor vascularity. Lesions exhibited homogeneous (n=8) and heterogeneous (n=10). Testicular microlithiasis was present in 4 of 9 patients with TART. Doppler ultrasound showed normal testicular vessels passing through the mass which were undisturbed, not displaced and not change in caliber. MRI features were the following: all lesions were hypointense on T2- and hyperintense (n=12) and isointense (n=6) on T1-weighted images. All masses revealed homogeneous contrast enhancement on postcontrast T1-weighted images.

CONCLUSIONS

Ultrasonography and MRI are good methods for detecting and monitoring TART. US is the first preferable modality because it is quick and cheap than MRI. Bilateral mostly hypoechoic lesions depicted around the mediastinum testis with no mass effect is highly suggestive for the diagnosis of testicular adrenal rest tissues on ultrasonography. Normal testicular vessels coursing through the lesions undisturbed and not change in caliber is described specific for this kind of tumors.

Cardiac calcified amorphous tumors: CT and MRI findings

PURPOSE

We aimed to evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac calcified amorphous tumors (CATs).

METHODS

CT and MRI findings of cardiac CATs in 12 patients were included. We retrospectively examined patient demographics, location, size, shape configuration, imaging features, calcification distribution of tumors, and accompanying medical problems.

RESULTS

There was a female predominance (75%), with a mean age at presentation of 65 years. Patients were mostly asymptomatic on presentation (58.3%). The left ventricle of the heart was mostly involved (91%). CT findings of CATs were classified as partial calcification with a hypodense mass in four patients or a diffuse calcified form in eight. Calcification was predominant with large foci appearance as in partially calcified masses. On T1- and T2-weighted magnetic resonance images, CATs appeared hypointense and showed no contrast enhancement.

CONCLUSION

The shape and configuration of cardiac CATs are variable with a narrow spectrum of CT and MRI findings, but large foci in a partially calcified mass or diffuse calcification of a mass on CT is very important in the diagnosis of cardiac CATs. Masses show a low signal intensity on T1- and T2-weighted images with no contrast enhancement on MRI.

Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update

Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

PURPOSE

We aimed to evaluate the utility of cardiac magnetic resonance imaging (MRI) for the diagnosis of infective endocarditis (IE).

METHODS

Sixteen patients with a preliminary diagnosis of IE (10 women and six men; age range, 4-66 years) were referred for cardiac MRI. MRI sequences were as follows: echo-planar cine true fast imaging with steady-state precession (true-FISP), dark-blood fast spin echo T1-weighted imaging, T2-weighted imaging, dark-blood half-Fourier single shot turbo spin echo (HASTE), and early contrast-enhanced first-pass fast low-angle shot (FLASH). Delayed contrast-enhanced images were obtained using three-dimensional inversion recovery FLASH after 15±5 min. The MRI features were evaluated, including valvular pathologies on cine MRI and contrast enhancement on the walls of the cardiac chambers, major thoracic vasculature, and paravalvular tissue, attributable to endothelial extension of inflammation on contrast-enhanced images.

RESULTS

Fourteen valvular vegetations were detected in eleven patients on cardiac MRI. It was not possible to depict valvular vegetations in five patients. Vegetations were detected on the aortic valve (n=7), mitral valve (n=3), tricuspid and pulmonary valves (n=1). Delayed contrast enhancement attributable to extension of inflammation was observed on the aortic wall and aortic root (n=11), paravalvular tissue (n=4), mitral valve (n=2), walls of the cardiac chambers (n=6), interventricular septum (n=3), and wall of the pulmonary artery and superior mesenteric artery (n=1).

CONCLUSION

Valvular vegetation features of IE can be detected by MRI. Moreover, in the absence of vegetations, detection of delayed enhancement representing endothelial inflammation of the cardiovascular structures can contribute to the diagnosis and treatment planning of IE.