In order to analyse the geometry-to-pressure re­ lationship in the human elbow joint, four speci­mens were investigated by magnetic resonance imaging. Sagittal sections of the humero-radial and humero-ulnar joints were obtained at a re­ solution of 1 x 0.2 x 0.2 mm3, using a fat-sup­ pressed FLASH sequence. From these images the relative form (congruity / incongruity) of the articular bodies was qualitatively evaluated. In a second step, three finite element models were designecl according to the MRI findings ancl loa­ ded with 100 to 6900 N. In the first moclel a he­ mispherical joint head was pressed into a he­ mispherical socket, in the second the socket was macle 2.5% wicler and in the third 2.5% deeper than the joint heacl. These variations in joint sha­ pe hacl profouncl effects on the clistribution of normal stresses. Whereas in models 1 ancl 2 the stress maxima were alwa ys in the centre of the socket, in rnodel 3 the location of the maxima depended on the magnitucle of the resultant for­ ce and showecl a more peripheral location at low ancl moderare joint loacls. Although the pressures calculated for model 2 were higher than those for model 1, those of moclel 3 (con­ cave incongruity) were considerably lower than those of models 1 and 2. These results tie in well with the biomechanical assessment of elbow joint contact areas ancl morphological findings on articular cartilage thickness and subchonclral bone density. A combination of MRI and finite element analysis may become a powerful tool in the stress / strain analysis of human joints ancl provide valuable information for the stucly of the functional adaptation of connective tissues as well as of the mechanical factors involved in the pathogenesis of osteoarthrosis.

The results of this study indicated that MR-VAB offers excellent accuracy. Small lesion size did not prove to be a limitation.

AbstractBACKGROUNDThe objective of this study was to determine the accuracy, reproducibility, and clinical value of magnetic resonance (MR)‐guided, vacuum‐assisted breast biopsy (MR‐VAB) in a prospective, multicenter study.METHODSIn 5 European centers, MR‐VAB was performed or attempted on 538 suspicious lesions that were visible or could targeted only by MR imaging (MRI). Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign biopsy results were verified by retrospective correlation of histology with preinterventional and postinterventional MRI studies. Follow‐up of 24–48 months (median, 32 months) was available for 491 of 538 patients.RESULTSMR‐VAB was unsuccessful or was not completed in 21 of 538 patients, for which an immediate repeat biopsy was recommended. Five hundred seventeen of 538 performed VAB procedures (96%) were successful. Histology yielded 138 (27%) malignancies, 17 (3%) atypical ductal hyperplasias, and 362 (70%) benign entities. No false‐negative diagnoses occurred among the 517 successful MR‐VAB procedures. The positive predictive value of VAB depended on patient preselection, which differed according to the indication for the initial MRI study.CONCLUSIONSThe results of this study indicated that MR‐VAB offers excellent accuracy. Small lesion size did not prove to be a limitation. Cancer 2006. © 2006 American Cancer Society.

PURPOSE:To investigate the respective diagnostic accuracies of the different breast imaging modalities, i. e., mammography (Mx), high-frequency breast ultrasound (US), and dynamic contrast-enhanced breast (MRI) regarding the early diagnosis of familial (hereditary) breast cancer. MATERIALS AND METHODS:A prospective, non-randomized controlled clinical multi-center trial is performed at 4 academic tertiary care centers in Germany (Ulm, Munchen/Grosshadern, Munster and Bonn) for a total period of 4 years, sponsored by the German Cancer Aid. The protocol consists of semiannual clinical visits and breast ultrasound, and annual bilateral two-view Mx, US and MRI. Imaging studies were first analyzed independently, then Mx was read in conjunction with US, followed by Mx combined with MRI, and finally, all three imaging modalities were read in synopsis. We present the concept and first results of this trial. RESULTS:So far, 748 screening rounds are available for analysis in 613 women. A total of 12 breast cancers have been identified, with 11/12 cases in the pTis or pT1/N0 stage. The mean size of detected invasive cancers was 7 mm. A total of 19 benign lesions were biopsied due to false-positive imaging diagnoses. The breast cancer detection rates were: Mx: 5/12 (42 %), US 3/12 (25 %), MRI 10/12 (83 %), and the positive predictive values: Mx 5/17 (29 %), US 3/15 (30 %), and MRI 10/23 (43 %). CONCLUSION:The preliminary data suggest that early diagnosis of familial breast cancer is feasible by intensified surveillance, in particular with the addition of MRI.

METHODS:We performed Vacora biopsy on 53 patients for minimally invasive breast diagnostics. Each histologically malignant lesion underwent surgery. The histopathology of the Vacora biopsy was then compared to the surgical report. When there was a discrepancy between Vacora histopathology and the report, the patient underwent open biopsy. In all patients with benign histopathology results, sonography was performed 5-7 days after biopsy and after 3 months.RESULTS:We performed biopsies on two lesions in eight patients, and on three lesions in one patient. Mean age of the patients was 52.1+/-12.8 years. A total of 62 lesions were examined. Mean size of the lesions was 13.3+/-9.6 mm. Fourteen (26.4%) were malignant (n=2 DCIS, n=12 invasive carcinoma). Histological grading was identical for Vacora biopsy and the surgical specimens. One case showed ADH by Vacora biopsy, which was confirmed by open biopsy. Vacora biopsy generated one false negative. There were a total of 36 benign lesions.CONCLUSION:Vacora biopsy under sonographic guidance is a method which is easy to handle, diagnostically accurate and without severe complications. Due to higher costs in comparison to high speed core biopsy, Vacora biopsy should be performed only in cases in which high speed core biopsy is not expected to result in a valid result.

Suspekte Befunde in der Mammographie können grob in drei Kategorien eingeteilt werden. Dazu gehören speziell geformte und verteilte und dadurch suspekte Mikrokalzifikationen, unscharfe Herdbefunde mit speziellen Eigenschaften, und Störungen der Parenchymarchitektur sowie Asymmetrien des Drüsenparenchyms. In diesem Verbund ist die Architekturstörung und die Asymmetrie des Drüsengewebes das am wenigsten spezifische Zeichen, doch liefert es wichtige Zusatzinformationen und sollte in jedem Fall dazu führen, dass die Aufmerksamkeit des Untersuchers geweckt wird. Durch eine subtile Analyse dieser Zeichen kann die Sensitivität der Mammographie deutlich gesteigert werden.

BACKGROUND:It was to analyse whether 3D breast US is able to enhance the diagnosis of focal breast lesions.MATERIAL AND METHODS:60 patients were examined with 2D- and 3D US (GE logiq 9, 14 MHz). The solid lesions were analyzed by using the BIRADS classification. As standard of reference, histopathologic results were available in all cases.RESULTS:38 malignant and 22 benign lesions were analyzed. With 2D US the sensitivity/specificity was 92/81%, with 3D US 97/72%, and by combination of 2D and 3D 97/81%. Characteristics of benign solid masses included a round or oval shape as well as clearly defined and sharply demarcated margins.CONCLUSIONS:3D US allows to demonstrate breast masses in multiple planes. Distorsion of the surrounding soft tissues is an important sign indicative of malignancy.

The O-twist marker is applicable for all examination modalities and biopsy needles or biopsy systems and represents an important development for breast cancer diagnostics.

Entwicklung eines Markierungsclips für die minimalinvasive Mammadiagnostik, der unter Ultraschall-, Mammographie- und MRT-Kontrolle abgesetzt und wieder dargestellt werden kann.

Ziele: Die Deutsche Krebshilfe hat eine Multicenterstudie ins Leben gerufen („EVA“-Studie), die in Form einer prospektiven klinischen Studie die standardisierte Analyse der Leistungsfähigkeit von Mammographie (Mx), hochauflösender Sonographie (US) und MRT zur Früherkennung des familiären Mammakarzinoms ermöglicht. Wir berichten über die erste Hälfte der Förderungsperiode. Methode: An 4 Radiologischen Universitätskliniken (Ulm, Großhadern, Münster, Bonn) wurden Frauen aus Hochrisiko-Familien über das Schwerpunktprogramm zum Familiären Mamma-und Ovarialkarzinom der DKH rekrutiert. Das Untersuchungsprotokoll besteht aus halbjährlichem US und klinischer Untersuchung, jährlicher Mx und MRT. Die Untersuchungen werden zunächst separat befundet, dann Mx + US kombiniert, dann Mx + MRT, US + MRT, schließlich alle 3 Verfahren. Ergebnis: Bislang sind 748 Screening-Runden bei 618 Frauen (mittleres Alter: 42 Jahre, 21–67) erfolgt. 12 Karzinome wurden bislang identifiziert, die sich in 11/12 Fällen im Stadium pTis- bzw. pT1/N0 befanden; mittlere Größe der 8 invasiven Karzinome: 7mm; 12/12 wurden als M0 kategorisiert. Ein Intervall-Karzinom ist nicht aufgetreten. Insgesamt 19 Biopsie-Empfehlungen erbrachten benigne Ergebnisse (Fibroadenome, Adenose; radiäre Narbe, ADH). Die MRT erlaubte die Diagnose von 10/12 Karzinome; in 2 Fällen wurde die Diagnose über die Mammographie gestellt. Kein Karzinom wurde nur aufgrund des Ultraschalls diagnostiziert. Sensitivität: Mx: 42%; US: 25%; MRT: 83%. PPV: Mx: 29%; US: 20%; MRT: 43%. Schlussfolgerung: Diese Zwischenergebnisse deuten darauf hin, dass mittels einer intensivierten Früherkennung (d.h. unter Einbeziehung speziell der MRT) die Früherkennung des familiären Mammakarzinoms in einem prognostisch günstigen Stadium ermöglicht wird.

Die Indikation zur Durchführung einer primär systemischen Chemotherapie (PST) wurde vom lokal fortgeschrittenen und inflammatorischen auf operable Mammakarzinome erweitert. Die Vorteile liegen in der In-vivo-Testung des Tumoransprechens und in der erhöhten Rate an brusterhaltenden Operationen, ohne die onkologischen Zielparameter zu kompromittieren. Übereinstimmend wird die lokale R0-Exzision des Karzinoms in den „neuen“, d. h. in den durch die PST reduzierten Grenzen empfohlen. Die zuverlässigste Bildgebung nach PST erreicht offensichtlich die Kernspintomographie der Mamma. Onkoplastische Techniken im Rahmen der brusterhaltenden Therapie oder die nach notwendiger Mastektomie durchgeführten Verfahren der Rekonstruktion scheinen sicher. Die Axilladissektion bleibt der Goldstandard, die Sentinel-Node-Biopsie nach PST ist Gegenstand der klinischen Forschung.

Ziel dieser Arbeit war es, die Notwendigkeit der Biopsiehöhlenmarkierung mit einem Clip im Anschluss an eine MRT-gestützte Vakuumbiopsie (VB) zu überprüfen. Dabei wurde untersucht, wie genau sich der Clip in der Biopsiehöhle platzieren lässt, ob der Clip als Marker für eine erforderliche Drahtmarkierung nutzbar und inwieweit im zeitlichen Verlauf mit einer Dislokation des Clips zu rechnen ist.

In many radiological departments conventional radiography has been replaced by digital radiography. Therefore, the purpose of this study was to analyze the visual detection of osteopenia/osteoporosis with both digital and conventional radiographs. In 286 patients we retrospectively evaluated radiographs of the lumbar spine in two planes. One hundred twenty-eight patients had conventional and 158 patients had digital radiographs. Patients with pre-existing vertebral fractures were excluded. Four experienced musculoskeletal radiologists blinded to the values of DXA and to the patients' ages assessed independently from each other whether the bone density of the lumbar spines was normal or decreased. The results of dual X-ray absorptiometry served as the standard of reference. The threshold value for the diagnosis of osteopenia was a T-score less than -1 SD according to the WHO classification of osteoporosis. Sensitivity/specificity was 86%/36% for conventional and 72%/47% for digital radiographs. The overall diagnostic accuracy was 68% for conventional and 64% for digital radiographs. Eighty percent of the patients with osteopenia and 96% of the patients with osteoporosis were correctly assessed as true positive on conventional radiographs and 65% (osteopenia) and 82% (osteoporosis) on digital radiographs. Interobserver agreement was markedly lower for digital (35%) than for conventional radiographs (73%). However, the differences were not statistically significant. There is no major difference in diagnostic accuracy in the assessment of osteopenia/osteoporosis using digital and conventional radiographs, respectively. However, the high interobserver variance on digital radiographs indicates that visual assessment of osteoporosis/osteopenia is problematic, which may be due to image processing and postprocessing algorithms that manipulate the visual aspect of bone density.

Purpose.The purpose of our study was to determine the placement accuracy, usefulness as a guide for wire localization, and long-term stability of tissue marker clips following MR-guided vacuum-assisted biopsy (VB) of breast lesions. Methods. During a 2-year period, MR-guided VB with an 11-gauge device was performed in 79 lesions. In 26 lesions a marker clip was placed at the biopsy site. Results. In 18 cases, the clip was shown to be closely adjacent to the lesion on postinterventional MR images. In seven cases in which minor bleeding occurred, the clip dislocated (<= 15 mm) in the direction of the needle pathway. In one case dislocation in the dorsal direction (: 5 mm) was observed. In eight cases with a malignant or borderline histology according to the VB, the marker clips served as targets for mammographically guided wire localization. In all of those patients, histology results derived from open surgery confirmed those of VB. Eighteen patients with benign findings according to the VB were followed up 6 months later. Among these cases we found a significant displacement of the marker clip in one case (3 cm). The clip generally caused a round artifact (diameter of 9 2 mm). In two cases it was not possible to determine whether the lesion had been removed completely or was just behind the artifact caused by the clip. Conclusion. Based on our results, clip marker placement following MR-guided vacuum biopsy should be called into question due to the possibility of masking the lesion by a metallic artifact and because of possible dislocation.

Der Lymphknotenstatus ist nach wie vor der wichtigste prognostische Faktor in der Therapie des Mammakarzinoms mit zum Teil erheblicher Armmorbidität nach axillärer Lymphonodektomie. Zunehmend stellt daher die Sentinel-Node-Biopsie ein etabliertes Verfahren für das unifokale cT1, cN0 Mammakarzinom dar. Die Rolle der Sentinel-Node-Biopsie (SNB) in der Therapie des duktalen Carcinoma in situ (DCIS) sowie des duktalen Carcinoma in situ mit Mikroinvasion ist derzeit ein nicht etabliertes und diskutiertes Verfahren. Am Beispiel eines ausgedehnten DCIS mit Mikroinvasion wird die Problematik, Indikation, pathologische Aufarbeitung und Wertigkeit der SNB diskutiert. Zusammenfassend kann die SNB bei Patientinnen mit indizierter Ablatio simplex bei ausgedehntem, histologisch gesichertem DCIS und hohem Verdacht einer Mikroinvasion zur Vermeidung einer dann gegebenenfalls notwendigen, sekundären, komplettierenden Axillaoperation durchgeführt werden.

The axillary lymph node status is the most important prognostic factor in the treatment of early breast cancer but with considerable morbidity after complete axillary dissection. Sentinel node biopsy (SNB) is established in surgical routine treatment for breast cancer stage T1, N0. The role of SNB in the treatment of pure ductal carcinoma in situ (DCIS) and microinvasive breast cancer is controversial. The following case report and review discusses the importance of SNB for these two entities. The case shows an extensive DCIS with microinvasion in the final pathology report after secondary thorough workup of the breast parenchyma with the presence of microinvasion in one sentinel node. It is recommended to carry out SNB in patients with indication for mastectomy due to extensive DCIS and high suspicion of microinvasion to forestall a second axillary surgery.

Im Rahmen der minimalinvasiven Mammadiagnostik wurde bei 53 Patientinnen eine Vacora-Biopsie durchgeführt. Alle histologisch malignen Läsionen wurden operiert. Bei diskordanten Ergebnissen der Vacora-Biopsie und der Bildgebung oder bei atypischer duktaler Hyperplasie wurde eine offene Biopsie durchgeführt. Alle Patientinnen mit einem benignen histologischen Ergebnis der Vacora-Biopsie wurden nach 5–7 Tagen und nach 3 Monaten nachuntersucht.