Faculty Bibliography

OBJECTIVE: Our aim was to evaluate the frequency and outcomes of incidental breast lesions detected on abdominal MRI examinations. MATERIALS AND METHODS: Abdominal MRI reports for 11,462 women imaged at our institution from November 2007 through December 2014 were reviewed to identify those reporting an incidental breast lesion. Available breast imaging and pathology results were assessed to identify outcomes in these lesions. RESULTS: Incidental breast lesions were described in the MRI reports of 292 (3%) patients who underwent abdominal MRI during the study period; breast imaging was recommended for 192 of these 292 (66%) patients. Sixty-three of the 192 (33%) patients for whom follow-up breast imaging was recommended underwent such imaging at our institution. Twenty-one of these 63 (33%) lesions underwent biopsy or surgery; histologic sampling of these lesions yielded seven incidental cancers (invasive ductal, n = 6; invasive lobular, n = 1) and 14 benign diagnoses. Three additional cancers (invasive ductal, n = 2; invasive lobular, n = 1) and three benign diagnoses were discovered at pathology at outside institutions. Of the remaining 165 patients without a histologic diagnosis, the lesions in 95 (58%) patients were presumed to be benign because of stability over time. Seven of the 10 patients with a diagnosis of incidental cancer (age range, 53-86 years; mean +/- SD, 67.0 +/- 10.6 years) had not undergone screening mammography at our institution. The frequency of incidental breast cancer was 11% of patients subsequently undergoing follow-up breast imaging at our institution, 3% of all patients with reported breast lesions, and 0.09% of patients undergoing abdominal MRI examinations. CONCLUSION: Although incidental breast lesions were rarely detected on abdominal MRI, a considerable number of these lesions were found to represent breast cancer, particularly when leading to a recommendation for follow-up breast imaging. Therefore, it is important for radiologists interpreting abdominal MRI examinations to carefully evaluate for the presence of breast abnormalities.

OBJECTIVE: The customer intimacy business model has emerged as a key operational approach for health care organizations as they move toward patient-centered care. The question arises how the customer intimacy approach can be implemented in the clinical setting and whether it can help practitioners address problems and improve quality of care. CONCLUSION: Breast cancer screening and its emphasis on the patient perspective provides an interesting case study for understanding how the customer intimacy approach can be integrated into radiologic practice to improve the patient experience.

Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation. We described two patients with prior PAAG breast augmentation with physical exam and imaging findings concerning for malignancy. We reviewed the literature on PAAG breast augmentation and compare PAAG to silicone breast augmentation. The management of such patients is discussed.

PURPOSE: To assess the percentage of first-trimester pregnancies with bleeding that demonstrate a visible sac but lack an identifiable embryo and have a mean sac diameter (MSD) in the controversial range of 16-20 mm. METHODS: Retrospective study of all first-trimester sonograms among women with vaginal bleeding during a 4-year interval. RESULTS: The study cohort consisted of 546 first- trimester sonograms. An embryo was not seen in 132 cases (24%). Of these, the MSD in 69 cases (52%) was <16 mm, between 16 and 19 mm in 20 cases (15%), or >or=20 mm in 39 cases (30%). The percentage of women who were threatening to abort who demonstrated a visible sac but lacked an identifiable embryo and had a MSD in the controversial range of 16-20 mm was 3.7% (20/546). CONCLUSION: We found that of 546 sonograms undertaken in pregnant women with vaginal bleeding in the first trimester, only 20 patients (3.7%) fell in the MSD range of 16-20 mm. Therefore, even among those diagnosticians who adopt the most stringent criterion (MSD = 20 mm), an additional examination would be requested in fewer than 1 in 25 patients

OBJECTIVE: The purpose of this study was to assess outcomes in embryos with a crown-rump length (CRL) of 5 mm or less without embryonic cardiac activity (ECA) among pregnant women with vaginal bleeding in the first trimester. METHODS: A retrospective study of all first-trimester sonograms in women with vaginal bleeding from 1999 to 2002 was conducted. RESULTS: Thirty-seven embryos without detectable ECA that had a CRL of 5 mm or less were identified. All resulted in pregnancy failure. The breakdown of these embryos by CRL was as follows: 13 were 5 mm; 10 ranged from 4 to 4.9 mm; 11 ranged from 3 to 3.9 mm; and 3 ranged from 2 to 2.9 mm. CONCLUSIONS: In pregnant women with vaginal bleeding, embryos of 5 mm and smaller without a heartbeat all resulted in pregnancy failure

Contrast-enhanced magnetic resonance angiography (MRA) has demonstrated the potential for detecting gastrointestinal bleeding in animal studies. We report a case of active lower gastrointestinal bleed diagnosed with MRA in an elderly patient. Clinical, radiologic, and surgical findings are described