Background/Objectives: Hepatic hemangiomas are the most common benign liver tumors, typically diagnosed confidently by their classic imaging features. However, a subset displays atypical characteristics that complicate diagnosis. We hypothesized that the term "atypical hemangioma" is used inconsistently and may contribute to both over-investigation of benign lesions and missed malignancies. Accordingly, this study aimed to assess the implications of the use of this term in radiology reports. Methods: This retrospective multicenter study reviewed 327 hepatic lesions labeled as atypical hemangiomas in radiology reports from two tertiary hospitals between 2013 and 2023. Two abdominal radiologists independently assessed imaging characteristics. Final diagnoses were based on imaging stability, histopathology or clinical follow-up. Results: Of the 327 lesions, 305 (93.3%) were benign and 22 (6.7%) malignant. Among the malignant lesions, 11 (50%) had no recommendations for further workup, and 10 (45%) did not mention malignancy in the differential diagnosis. Malignant lesions were significantly larger (mean size: 49.5-50.8 mm vs. 28.1-29.1 mm; p < 0.001), more likely to have ill-defined margins (50-54.5% vs. 17.9-18.1%; p ≤ 0.001), early heterogeneous enhancement (46.2% vs. ~9.5%; p < 0.001), and restricted diffusion (75-100% vs. 7.8-17.6%; p < 0.001). Among the benign lesions, 128 (42%) could have been confidently diagnosed at baseline, yet 62 of these lesions underwent unnecessary additional workup. Conclusions: The term "atypical hemangioma" is inconsistently used and associated with both delayed cancer diagnosis and excessive workup of benign lesions. Standardized terminology and risk-adapted strategies may improve diagnostic accuracy, optimize management, and minimize patient harm. Prospective validation of standardized imaging criteria is warranted.

The PROMISE framework standardizes PSMA PET interpretation using reference organs, particularly the liver. For hepatobiliary-excreted tracers (e.g., 18F-PSMA-1007), the spleen was proposed as an alternative reference, though without quantitative validation. We evaluated PSMA-ligand uptake patterns among 18F-PSMA-1007, 68Ga-PSMA-11, and 18F-DCFPyL to assess the validity of spleen-based referencing and develop a simple approach that may harmonize 18F-PSMA-1007 liver uptake with that of renally-excreted tracers. 331 consecutive PSMA PET-CT studies (n = 118/95/118 for 68Ga-PSMA-11/18F-PSMA-1007/18F-DCFPyL) were analyzed: SUVs were retrospectively measured in all studies in reference tissues (blood pool, liver, parotid), with SUVspleen also recorded for 18F-PSMA-1007. SUVliver differed markedly across tracers: 18F-PSMA-1007 (13.95 ± 4.71) > 68Ga-PSMA-11 (7.45 ± 4.59) ≈ 18F-DCFPyL (8.11 ± 1.78), p < 0.01. The elevated 18F-PSMA-1007 liver uptake expanded the PROMISE score-1 range (SUV range between SUVblood pool and SUVliver) and compressed that of score-2 (SUV range between SUVliver and SUVparotid). SUVspleen in this group (12.24 ± 5.67) showed only moderate correlation with SUVliver (r = 0.43) and exceeded SUVliver in 29

BACKGROUND:Computed tomography (CT)-derived body composition parameters, including skeletal muscle and fat indices, are prognosticators in oncology. Most studies focus on baseline body-composition parameters; however, changes during treatment may provide better prognostic value. Standardized methods for measuring/reporting these parameters remain limited. METHODS:This retrospective study included patients who were treated with immunotherapy for non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), or melanoma between 2017 and 2024 and had technically adequate baseline and follow-up CT scans. Body composition was analyzed using a novel, fully automated software (CompoCT) for L3 slice selection and segmentation. Body composition indices (e.g., skeletal muscle index [SMI]) were calculated by dividing the cross-sectional area by the patient's height squared. RESULTS:The cohort included 376 patients (mean [SD] age 66.4 [11.4] years, 67.3% male, 72.6% NSCLC, 14.6% RCC, and 12.8% melanoma). During a median follow-up of 21 months, 220 (58.5%) died. Baseline body composition parameters were not associated with mortality, except for a weak protective effect of higher SMI (HR = 0.98, p = 0.043). In contrast, longitudinal decreases were strongly associated with increased mortality. Relative decreases in SMI (HR, 1.17; 95% CI, 1.07-1.27) or subcutaneous fat index (SFI) (HR, 1.11; 95% CI, 1.07-1.15) significantly increased mortality risk. Multivariate models showed similar concordance (0.65) and identified older age, NSCLC tumor type, and relative decreases in SMI and SFI (per 5% units) as independent predictors of mortality. CONCLUSIONS:Longitudinal decreases in skeletal muscle and subcutaneous fat were independent predictors of mortality in immunotherapy-treated patients. Automated CT-based body composition analysis may support treatment decisions during immunotherapy.

Background: Percutaneous liver biopsy is a cornerstone in the diagnostic and therapeutic management of pediatric liver diseases. However, data on the optimal needle gauge for coaxial techniques in children remain scarce. Smaller-gauge needles may theoretically enhance safety but could potentially compromise diagnostic yield. Objectives: The primary objective of this study was to evaluate and compare the safety and diagnostic clinical adequacy of ultrasound-guided percutaneous liver biopsies performed with semi-automated 20G versus 18G coaxial needles in pediatric patients. Patients and Methods: This retrospective cohort study included consecutive patients aged ≤19 years who underwent percutaneous non-targeted liver biopsies at a tertiary medical center between 2006 and 2012. Patient demographics, biopsy technique parameters (including needle gauge, number of cores, and tract embolization), and procedure-related complications were analyzed. Procedural success was defined by diagnostic and clinical adequacy, requiring a definitive pathology report and the presence of ≥7 portal tracts (the widely accepted threshold for a reliable histologic diagnosis). Complications were classified according to the Society of Interventional Radiology guidelines. Results: A total of 320 biopsies were performed in 260 patients (44.6% female; mean age 7.4 ± 6.0 years). Common indications included post-liver transplantation surveillance (28.4%) and unexplained liver enzyme elevation (22.5%). Biopsies were performed using 18G (n = 148; 46.3%) or 20G (n = 172; 53.7%) coaxial needles. Diagnostic and clinical adequacy was achieved in 100% of the procedures, with biopsy results directly influencing clinical management in 39.7% of cases. The overall complication rate was 5.3% (3.4% minor, 1.9% major), with no procedure-related mortality. While raw complication rates were numerically higher in the 20G group (likely to reflect an operator-driven selection bias for younger or higher-risk patients), the differences between the 18G and 20G needles were not statistically significant. Notably, the use of the 20G needle was associated with a significantly reduced clinical need for post-biopsy tract embolization. Conclusions: Our findings demonstrate no statistically significant differences in complication rates or diagnostic clinical adequacy between 18G and 20G coaxial needles for pediatric percutaneous liver biopsies. When selected based on appropriate clinical judgment, the 20G needle provides a high diagnostic yield and serves as an effective option, particularly for reducing the need for tract embolization. However, both 18G and 20G needles represent acceptable clinical options within the pediatric interventional armamentarium. Ultimately, the choice of needle gauge should be meticulously tailored to individual patient characteristics, bleeding risk profiles, and specific clinical indications, rather than uniformly recommending a smaller gauge across all pediatric age groups.

Screening mammography (MG) and ultrasound (US) are used for breast cancer (BC) diagnostic, offering complementary diagnostic information. Existing classification approaches, including artificial intelligence (AI), primarily focus on distinguishing between benign and malignant cases, overlooking the critical distinction between normal, benign, and malignant classes—thereby assuming the presence of abnormalities. Additionally, many methods depend on physician input, such as manually cropping regions of interest (ROIs) or contouring areas in US, which limits automation and scalability. We propose a fully automatic patient-level Multi-Modality (MM) screening classification without physician input. Our learning framework that integrates MG and US data to improve classification without manual physician input. Our approach is the first to leverage C-view MG, a synthesized MG format, within a large dataset of 1250 patients with paired MG and US images. The framework employs an ArcFace layer to enhance tumor class separation. We evaluated two fusion techniques — feature concatenation and cross-attention — to effectively combine MG and US. Our MM model achieves Area Under the Curve (AUCs) of 95.5%, 97.5%, 98.9% for distinguishing normal, benign, and malignant cases, respectively. The evaluations highlight benefits of C-view MG and ArcFace, showing substantial improvements over models that exclude components or use architectures designed for cropped images and binary (benign/malignant) classification in prior studies. This work highlights the potential of MM approaches in BC classification, especially when combining complementary modalities, including C-View MG, with advanced imaging techniques and feature fusion strategies. By eliminating the need for manual physician input, our framework represents a significant step toward efficient, automated diagnostic solutions.

Background: Computed tomography (CT)-guided lung biopsy plays a pivotal role in diagnosing thoracic lesions. However, its diagnostic yield may be compromised in large, necrotic, or heterogeneous tumours due to inadvertent sampling of non-viable tissue. Dual-energy CT (DECT) iodine mapping provides functional imaging by identifying iodine-avid, perfused areas, thereby offering the potential to improve biopsy targeting. Methods: This single-centre retrospective study evaluated the clinical feasibility and diagnostic performance of DECT-guided biopsy. Adult patients with suspected necrotic lung or mediastinal lesions who underwent DECT iodine mapping prior to CT-guided biopsy between April 2021 and December 2022 were evaluated. DECT iodine maps were generated using dual-source CT and used to identify viable tumour regions for targeted biopsy. The primary outcome was diagnostic yield, defined as obtaining a definitive histopathological diagnosis. Secondary outcomes included safety and adequacy of samples for molecular testing. Results: Twenty patients were included. A definitive diagnosis was obtained in 18/20 biopsies (90%). Diagnostic yield was 9/11 (81.8%) for pulmonary lesions and 9/9 (100%) for mediastinal/pleural lesions. Diagnoses included non-small-cell lung cancer (n = 8), Hodgkin lymphoma (n = 4), thymoma (n = 3), and other malignancies (n = 3). Biopsy material was sufficient for additional molecular testing in 13/20 cases (65%). Complications were minor (one pneumothorax not requiring drainage and two self-limited bleeding events). Conclusions: DECT iodine map-guided targeting was feasible in this retrospective cohort and was associated with high diagnostic yield, low complication rates, and frequent acquisition of tissue suitable for molecular analyses. Prospective controlled studies are needed to quantify benefit over conventional CT guidance.

PURPOSE:To evaluate long-term effectiveness, safety, and recurrence rates of combined cystic duct embolization (CDE) and chemical gallbladder ablation (CGA) in high-risk patients with acute cholecystitis (AC) unsuitable for surgery. MATERIALS AND METHODS:In this retrospective cohort study (2013-2025), 19 high-risk patients (mean age, 77.7 years [SD ± 19.3]) underwent CDE followed by CGA using 3% Aethoxysklerol or Glubran with ethiodized oil. All patients initially underwent percutaneous cholecystostomy. Technical failure was defined as the inability to catheterize the cystic duct. Clinical success was defined as the resolution of symptoms without recurrence. Freedom from recurrent cholecystitis was estimated using Kaplan-Meier analysis. RESULTS:Technical success was achieved in 17 (89.5%) of 19 patients; 2 failures were due to inability to cannulate the cystic duct (technical failure). Among the 17 patients treated, clinical success was achieved in 14 (82.4%). Clinical failure occurred in 3 patients (17.6%): 1 with persistent bile leakage and 2 with late recurrent cholecystitis (manifesting as perforation in 1 case and cholangitis in another). No procedure-related mortality occurred. Kaplan-Meier analysis demonstrated a sustained high probability of freedom from recurrent cholecystitis over a median follow-up of 43.2 months. CONCLUSIONS:CDE combined with CGA appears to be a viable and effective minimally invasive option for AC in nonsurgical patients, yielding high long-term success. However, late recurrence is possible, necessitating careful patient selection and long-term surveillance.

Background: Limited data exist on the comparative diagnostic value of CT urography (CTU) versus unenhanced CT in evaluating the upper urinary tract in young adults (<50 years) with hematuria in active military service. This population may face an increased risk of urinary tract malignancies due to occupational exposures. Methods: We conducted a retrospective cohort study of 277 consecutive Israel Defense Forces personnel under 50 years old with new-onset hematuria referred for CT evaluation between 2011 and 2020. Two experienced radiologists first interpreted unenhanced CT images, followed by a review of contrast-enhanced phases. Findings were classified based on their detectability on unenhanced CT and whether contrast phases were required. Results: Of the 277 patients, 270 had microscopic hematuria and 7 had macroscopic hematuria. Imaging was normal in 158 cases. Among 119 patients (43%) with positive findings, 46 (16.6%) had clinically significant findings requiring follow-up or treatment. Of these, 42 (91%) were detectable on unenhanced CT alone. Contrast phases were requested in 15 cases (5.4%) and revealed additional benign findings. No urinary tract malignancies were identified. Conclusions: Unenhanced CT may be sufficient for evaluating new-onset hematuria in adults under 50, including active military personnel, minimizing the need for contrast administration.

Background:Physiologic hydronephrosis in pregnancy is usually asymptomatic, however, definitions of symptomatic hydronephrosis vary, pain being the only criterion in some cases. We found no literature validating physiologic hydronephrosis as a cause of emergent right abdominal pain. We aimed to evaluate whether the incidence of hydronephrosis is higher in patients with right abdominal pain and no other identifiable cause, as compared to asymptomatic pregnant women (APW). Methods:A retrospective review of abdominal magnetic resonance imaging (MRI) was performed for acute abdominal pain (AAP) in pregnant patients with no identifiable cause, compared to MRI performed for fetal evaluation in APW. Two readers (R1/R2) performed qualitative evaluation of hydronephrosis and hydroureters, and quantitative measurement of ureteral maximal diameter. Inter-rater agreement was calculated. Results:The study included 39 AAP and 162 APW patients, mean ages 31.0±4 and 31.7±5 years respectively. Quantitative and qualitative measurements showed no statistically significant differences between the groups. Right hydronephrosis was found in 33.3%/53.8% of AAP versus 43.8%/45.1% of APW (P=0.280/P=0.324, R1/R2 respectively). Right hydroureter was found in 28.2%/33.3% of AAP versus 28.4%/30.9% of APW (P=0.946/P=0.765, R1/R2 respectively). Inter-reader agreement showed good to excellent reliability in qualitative and quantitative measurements. Conclusions:Emergent right abdominal pain in pregnant patients with no appendicitis or other identifiable causes was not related to a higher incidence of hydronephrosis or hydroureter, as compared to asymptomatic ambulatory pregnant patients. The findings suggest that emergent right abdominal pain in these patients is not necessarily attributable to physiologic hydronephrosis and alternative diagnoses should be carefully considered.

Introduction:Although breast pain as a sole symptom is very rarely associated with cancer, national guidelines recommend that all women with a complaint of breast pain have to be referred for ultrasound evaluation. This study sought to investigate the necessity of this practice. Methods:A retrospective study was conducted in consecutive women aged between 17 and 39 years, at average risk of breast cancer who presented at a major tertiary breast clinic with clinically significant breast pain (unilateral, unifocal, and noncyclic) in 2017-2023. Data on background, physical examination, imaging, and pathology were collected from the electronic medical records and analyzed by outcome. Results:The cohort included 814 women. Among the 574 women (70%) with a normal physical breast examination, ultrasound revealed normal findings or BI-RADS 1-2 lesions in 499 (87%), BI-RADS 3 lesions in 59 (10%), and BI-RADS 4 lesions in 16 (3%). Biopsies, performed in 30 BI-RADS 3 lesions and all BI-RADS 4 lesions, were benign. Half of the 337 patients with available follow-up data continued to attend the breast clinic (mean 3.5 ± 2.2 years). Among the 240 women (30%) with a palpable abnormality on breast examination, ultrasound revealed normal or benign BI-RADS 2 findings in 112 (47%), BI-RADS 3 lesions in 69 (29%), and BI-RADS 4-5 lesions in 59 (25%). Biopsies performed in BI-RADS 3 lesions (12%) were all benign. Biopsies, performed in all BI-RADS 4-5 lesions, yielded malignant pathology in 16 lesions (7%) (including IDC, DCIS, or angiosarcoma). The overall breast cancer risk was 2%. Ultrasound sensitivity was 94%, specificity 85%, and negative predictive value 99%. The negative predictive value for dedicated physical examination without imaging was 100%. The biopsy-proven positive predictive value was 0 in patients with a normal breast examination compared to 18% in patients with a palpable finding on breast examination (p = 0.0017). Conclusion:A subset of women <40 years old with average breast cancer risk and breast pain, who would normally be referred for imaging, can be triaged by a dedicated physical examination. Limiting ultrasound evaluation to those with palpable findings will spare patients and the healthcare system unnecessary radiology and biopsy studies.

Objectives: We aimed to compare the accuracy of ultrasound and computed tomography (CT) for the diagnosis of patients with suspected acute diverticulitis and to determine if ultrasound might serve as the primary tool for this purpose in the emergency department. Methods: A double-blind prospective study design was used. The study group included 142 consecutive patients with clinically suspected diverticulitis admitted to the emergency department of a tertiary medical center in 2016-2019. All underwent first ultrasound examination followed by abdominal CT. The final diagnosis was interpreted independently by an expert radiologist in a blinded fashion. Imaging data were compared with final diagnosis and we analyzed the findings against the medical, clinical, and laboratory data. Results: The final diagnosis was colonic diverticulitis in 98 patients. Sensitivity was 93.8% for ultrasound and 100% for CT; corresponding specificity rates were 86.7% and 100%. Agreement between the modalities was excellent (kappa = 0.81). CT demonstrated complicated diverticulosis in 18 patients: 8 pericolic abscesses, 9 micro-perforations, and 1 fistula. Ultrasound missed one abscess and five micro-perforations; however, all were small and were treated conservatively. Twenty-three patients were found to have an acute abdominal condition other than diverticulitis; sensitivity in these cases was 60.8% for ultrasound and 91.3% for CT. In 21 patients, the diagnosis was unknown. Conclusions: Ultrasound has similar sensitivity and specificity to CT for the diagnosis of acute colonic diverticulitis. We believe ultrasound may serve as the initial imaging modality in the emergency department, with CT reserved for large abscesses or inconclusive ultrasound findings.

CT-derived body composition (BC) metrics are associated with mortality in cancer patients at baseline and during treatment. However, the relationship between CT-derived BC metrics and blood biomarkers, and their independent prognostic value, has been scarcely evaluated. This study assessed the correlation between BC metrics and blood test results, and whether longitudinal changes independently predict mortality in patients receiving immunotherapy for solid tumors. We included patients treated with immunotherapy for non-small cell lung cancer (NSCLC), melanoma, or renal cell carcinoma (RCC) between 2017 and 2024, who had baseline and follow-up CT scans. Patients could be recorded more than once as distinct treatment events if there was a treatment break of ≥180 days, or a new drug combination. BC was analyzed using fully automated AI software (CompoCT@), measuring skeletal muscle (SM), including healthy muscle (HM) and steatotic muscle (StM); subcutaneous layer (SCL), comprising subcutaneous fat (SCF) and subcutaneous edema (SCE); and visceral fat (VF) at the L3 vertebral level. BC indices (e.g. SMI) were calculated by dividing the corresponding area (cm2) by the patient’s height squared (m2). Laboratory data included albumin, LDH, CRP, hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR) and white blood cell count (WBC). The cohort included 418 events from 392 patients (mean (median) age 66.2 (67) years; 66.5% male, 71.6% NSCLC, 14.2% melanoma, and 14.2% RCC). No significant correlations were observed between blood tests and CT BC metrics. Baseline values of albumin, Hb and NLR significantly correlated with mortality while baseline CT metrics did not. However, longitudinal percentage decrease in SMI (1/HR=25), HMI (1/HR=2.5) and SCFI (1/HR≈8.3) and increases in SCEI (HR=1.69), were all significantly associated with mortality (p<0.001). Changes in LDH, WBC, NLR, and Hb also correlated with mortality (HR=1.7;1.61;1.2;0.28 respectively), whereas changes in albumin levels did not. Three distinct multivariate models were constructed to evaluate the prognostic performance of different variable sets. The first model combined CT-derived BC metrics with blood biomarkers and demonstrated the highest predictive accuracy (concordance index [CI] = 0.78). The second model included only BC metrics (CI = 0.72), while the third relied solely on blood biomarkers (CI = 0.69). In the combined model, higher mortality was significantly associated with NSCLC diagnosis, longitudinal changes in CT-derived BC metrics, including %∆StMI, %∆HMI, and %∆SCFI, as well as baseline albumin values and changes in LDH levels (p < 0.05 for all). In patients with solid tumors receiving immunotherapy, longitudinal CT-based changes in muscle and fat were more predictive of mortality than traditional sarcopenia-related blood biomarkers. Opportunistic use of CT data, extracted via fully automated AI algorithms, may enhance clinical management decisions, by offering additive value to conventional blood tests related to muscle wasting and systemic inflammation. Shlomit Tamir, Hilla Vardi Behar, Ronen Tal, Ruth Tal Hasper, Mor Armoni, Hadar Pratt Aloni, Rotem Or Ad, Hillary Voet, Eli Atar, Ahuva Grubstein, Salomon Stemmer, Gal Markel. Dynamics in automatic CT based body composition and blood biomarkers in predicting mortality on immune therapy treated solid malignancy patients [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Artificial Intelligence and Machine Learning; 2025 Jul 10-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(13_Suppl):Abstract nr A064.

This paper introduces a deep learning (DL)-based framework for task-based ultrasound (US) beamforming, aiming to enhance clinical outcomes by integrating specific clinical tasks directly into the beamforming process. Task-based beamforming optimizes the beamformer not only for image quality but also for performance on a particular clinical task, such as lesion classification. The proposed framework explores two approaches: (1) a Joint Beamformer and Classifier (JBC) that classifies the US images generated by the beamformer to provide feedback for image quality improvement; and (2) a Channel Data Classifier Beamformer (CDCB) that incorporates classification directly at the channel data representation within the beamformer's bottleneck layer. Additionally, we introduce channel data augmentations to address challenges posed by noisy and limited in-vivo data. Numerical evaluations demonstrate that training with channel data augmentations significantly improves image quality. The proposed methods were evaluated against conventional Delay-and-Sum (DAS) and Minimum Variance (MV) beamforming techniques, demonstrating superior performance in terms of both image contrast and clinical relevance. Among all methods, the CDCB approach achieves the best results, outperforming others in terms of image quality and clinical relevance. These approaches exhibit significant potential for improving clinical relevance and image quality in ultrasound imaging.

BACKGROUND:Acute perforated cholecystitis (APC) is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality, particularly in elderly or high-risk patients. While emergency cholecystectomy is the standard of care, it may not be feasible in unstable patients. Percutaneous transhepatic cholecystostomy (PTC) offers a minimally invasive alternative. AIM:To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC. METHODS:We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center. All patients underwent PTC as the initial intervention. Data collected included demographics, comorbidities, laboratory and imaging findings, complications, and clinical outcomes over a 24-month follow-up. Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy. RESULTS:Thirty patients underwent PTC for APC. Half of the patients (n = 15) were stabilized and later underwent cholecystectomy; the remaining 15 were managed non-operatively. Patients in the non-surgical group were significantly older (87.1 ± 6.2 years vs 76.1 ± 7.4 years; P < 0.001). Clinical improvement was observed in 61.4% of non-operated patients, with eventual drain removal or closure. Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge. No significant differences were found in hospital stay or complication rates. During follow-up, three deaths occurred due to non-biliary causes. Only one patient required repeat drainage. CONCLUSION:PTC is a safe and effective initial treatment for APC, particularly in elderly and comorbid patients for whom surgery poses excessive risk. It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients. These findings support the broader use of PTC in the management of APC, although larger prospective studies are warranted.

Key Points :1. Diagnostic Efficacy of Unenhanced CT: The study reveals that unenhanced CT can detect 91% of clinically significant findings in young military personnel with hematuria, suggesting it may be sufficient as a first-line evaluation, reducing the need for contrast-enhanced phases.2. Low Incidence of Malignancy: AmoFng patients under 50, no cases of urinary malignancy were detected, reinforcing the idea that invasive contrast-enhanced imaging may be unnecessary in this low-risk population.3. Selective Use of Contrast: The study shows that contrast-enhanced imaging was required in only 5.4% of cases, primarily for benign conditions, supporting a more targeted use of contrast phases in specific clinical scenarios.

Objective: To determine the added value of digital breast tomosynthesis (DBT) in the assessment of lesions detected by contrast-enhanced mammography (CEM). Material and methods: A retrospective study was conducted in a tertiary university medical center. All CEM studies including DBT performed between January 2016 and December 2020 were included. Lesions were categorized and scored by four dedicated breast radiologists according to the recent CEM and DBT supplements to the Breast Imaging Reporting and Data System (BIRADS) lexicon. Changes in the BIRADS score of CEM-detected lesions with the addition of DBT were evaluated according to the pathology results and 1-year follow-up imaging study. Results: BIRADS scores of CEM-detected lesions were upgraded toward the lesion’s pathology with the addition of DBT (p > 0.0001), overall and for each reader. The difference in BIRADS scores before and after the addition of DBT was more significant for readers who were less experienced. The reason for changes in the BIRADS score was better lesion margin visibility. The main BIRADS descriptors applied in the malignant lesions were spiculations, calcifications, architectural distortion, and sharp or obscured margins. Conclusions: The addition of DBT to CEM provides valuable information on the enhancing lesion, leading to a more accurate BIRADS score.

The study investigates the potential link between gynecomastia and breast cancer in males carriers pf high risk breast cancer genes using mammography data between 2016 and 2023. Stratification by carriers status, breast cancer diagnosis, and gynecomastia presence reveals that carriers shows a higher likelihood of cancer diagnosis in cases of gynecomastia ( P < .05), suggesting a noteworthy association deserving further study. Introduction: The recommendations for annual mammography for male carriers with gynecomastia are controversial. This study investigated the potential link between gynecomastia and breast cancer in male carriers. Patients and Methods: The database of a tertiary medical center was retrospectively searched for all male patients who underwent at least 1 digital mammography study from 2016 to 2023. Known carriers of a pathogenic variant in a high-risk breast- cancer gene were identified. Patients were stratified by carrier status, diagnosis of breast cancer, and diagnosis of gynecomastia. Data on demographics, hormone profile, and pathology results were compared. Results: The cohort included 446 men of whom 82 were known carriers. Gynecomastia was diagnosed by mammography in 251 patients: 239/364 noncarriers (66%) and 12/82 carriers (15%) ( P < .0001). Breast cancer was found in 21/364 noncarriers (6%) and 6/82 carriers (7%) ( P < .6), and in 10/251 patients with gynecomastia (4%) and 17/193 (9%) without gynecomastia ( P < .05). Among patients without gynecomastia, the number of breast cancer cases was similar in carriers and noncarriers ( P = .3). Among patients with gynecomastia, the rate of breast cancer was higher in carriers ( P < .08). On logistic regression analysis, the effect of gynecomastia on carriers was significant ( P = .02). The odds ratio for a breast cancer diagnosis was 5.8 in the presence of gynecomastia (95% CI, 1.1-31, P < .04) and 0.52 in the absence of gynecomastia (95% CI, 0.2-1.7, P < .3). Conclusion: Gynecomastia may be associated with an increased risk of breast cancer in carriers. Larger studies are needed to determine whether and when to screen male carriers.

OBJECTIVE:Contrast-enhanced imaging, including magnetic resonance imaging and, more recently, contrast-enhanced digital mammography (CEM), is indicated for the precise diagnosis of invasive lobular carcinoma (ILC). The aim of our study was to further validate the use of CEM for evaluation of extent of disease in ILC cases, with digital breast tomosynthesis (DBT) as an adjunct. METHODS:A retrospective, institutional review board approved study was conducted in a tertiary medical center. All CEM examinations performed on ILC patients between 2017 and 2023 were reread by 2 dedicated breast radiologists. Clinical data and pathology reports were retrieved from electronic medical records. The longest diameter of the enhancing lesion was correlated to pathology findings. In addition, for each case, the readers provided brief commentary on the added value of DBT. RESULTS:Twenty-four CEM examinations were evaluated. The subjects in the study cohort were on average older than expected for ILC patients (74 vs 63 years) and were unable to undergo breast magnetic resonance imaging due to advanced age and comorbidities. Three subjects were treated with neoadjuvant therapy and thus were excluded from the correlation to pathology analysis. Enhancing lesions, ranging from 4-75 mm, strongly correlated to pathology results, with statistical significance. This was demonstrated for mass and nonmass lesions ( r  = 0.94, P  < 0.001 and r  = 0.99, P  = 0.002, respectively). For most lesions (17/24, 71%), readers remarked that the addition of DBT allowed for improved characterization of lesion margins, mainly detecting architectural distortion. CONCLUSIONS:When compared with the pathology findings, ILC was accurately diagnosed and assessed using CEM. The addition of DBT was reported by the interpreting radiologists as a valuable adjunct for margin analysis.