american journal of roentgenology fastmri

Biopsy of lesions detected only on MRI is most often performed with MRI-guided needle localization for surgical biopsy. One woman declined placement of a clip. 2020;214: 282-295. The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. Musculoskeletal radiologists reviewed two sets of knee MRIs from 108 patients, one set using the standard imaging techniques, and one set using the fastMRI AI model. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. After the examination, the unenhanced images were subtracted from the first contrast-enhanced images on a pixel-by-pixel basis. The skin surface was identified as the slice on which the indentations from the grid were evident as low-signal-intensity lines. Twenty-seven lesions underwent biopsy in 19 women having a median age of 51 years (range, 19–64 years). 10.2214/ajr.184.6.01841782. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. Postbiopsy collections of air (n = 5), fluid (n = 5), or both (n = 16) measuring a median of 1.9 cm (range, 0.6–3.2 cm) were observed on MRI in all lesions. An axial localizing T1-weighted sequence was performed, and the volume of interest was selected to include the compression device and a vitamin E marker placed over the expected lesion site. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI. The tray with the stylet was removed from the room before MRI was performed. In preparation for clip placement, the blue tubing was peeled off the biopsy handpiece, and the front end of the probe (the portion with the mouth) was separated from the hand-piece portion. 1A) by one of three attending radiologists specializing in breast imaging. Informed consent, preparation before the biopsy, biopsy equipment, and radiologists.—Informed consent was obtained for all biopsy and needle localization procedures. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. The clear obturator was then removed from the white introducer, and the sharp stylet was placed inside the white introducer as far as it could go (Fig. Cancer was found in eight (30%) of 27 lesions and in six (32%) of 19 women, based on review of vacuum-assisted biopsy and surgical histology. 1G). Our imaging protocol includes a localizing sequence followed by a sagittal fat-suppressed T2-weighted sequence (TR/TE, 4,000/85). Cancers diagnosed included multicentric, multifocal, or contralateral disease in women with proven cancer and cancers found at MRI screening of women at high risk for breast cancer. 1976. Vacuum-assisted biopsy and surgical histology are correlated in Table 1. The American journal of roentgenology, radium therapy, and nuclear medicine Abbreviation : Am J Roentgenol Radium Ther Nucl Med ISSN : 0002-9580 (Print) 0002-9580 (Linking) RESULTS. The sensitivity of MRI is high, reported as 94–100%, but it has lower specificity, ranging from 37% to 97% [4]. 1B). 1C). The time of the biopsy, in minutes, was determined by calculating the interval between the beginning of the MRI localizing sequence and the end of the final MRI sequence performed after clip deployment. 1E). Publication Start Year. MRI scans are excellent tools for doctors, allowing a … Publication End Year. A sagittal T1-weighted MRI study (3-mm slice thickness) was then performed. MRI-guided biopsy of a smooth mass yielded fibroadenoma and fibrosis; surgery revealed microscopic DCIS. Among the 14 hematomas, eight were mammographic masses measuring a median of 2.3 cm (range, 1.5–3.0 cm), and six were more subtle increased density at the biopsy site. Twenty women scheduled for MRI-guided needle localization and surgical excision were prospectively asked to participate in this study. Single lesions in 11 women underwent biopsy and two lesions in eight women underwent biopsy. Like many of the more long-lived academic publications, there have been a number of name changes over the years (see below). Country of Publication. A paper written by the team describing the new technology is to be published in the American Journal of Roentgenology. We encountered some difficulties with clip deployment, with a second attempt necessary in almost one quarter of the cases. False-negative results are a potential problem during any biopsy: reported false-negative rates are 0–8% for stereotactic 14-gauge automated core biopsy, 3% for stereotactic 11-gauge vacuum-assisted biopsy, and 0–8% for needle localization and surgical biopsy [38, 39]. Obtaining a two-view mammogram after biopsy is essential to assess location of the clip with respect to the biopsy cavity. The impact factor (IF), also denoted as Journal impact factor (JIF), of an academic journal is a measure of the yearly average number of citations to recent articles published in that journal. Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience. Tissue was acquired by stepping on the foot pedal. The median maximal distance from the clip to the localizing wire was 0.6 cm (range, 0.1–4.1 cm). Address correspondence to L. Liberman ([email protected]). Our goal was to use DL to accelerate MRI … Recognized as an undisputed leader in the field for over 100 years, the AJR is for radiologists who need clinically useful information; cutting-edge research; and educational and SAM/CME articles. MRI review suggests that the MRI target may have been excised and that the microscopic DCIS in the surgical specimen was occult at MRI (Fig. The goal of the ARRS is maintained through an annual scientific and educational meeting and through publication of the American Journal of Roentgenology, … MRI-guided vacuum-assisted breast biopsy, which has been successfully performed in more than 500 lesions in Europe [29], was recently approved for use in the United States. A woman was invited to participate in the study if she was scheduled for MRI-guided needle localization of a nonpalpable mammographically occult lesion, if she had undergone diagnostic breast MRI at our institution for screening of women who are at high risk for breast cancer or for extent of disease assessment, if logistics (staffing, magnet time, and operating room schedules) allowed the biopsy to be performed on the day of her surgery, and if her surgeon approved her participation. Total imaging time per breast, including three contrast-enhanced acquisitions, was approximately 20 min. Indications for Breast MRI and MRI-Guided Needle Localization, MRI-Guided Vacuum-Assisted Biopsy Technique, Review of Mammograms Obtained After Biopsy, Correlating Vacuum-Assisted Biopsy and Surgical Histology, Original Research. These new abbreviated protocols could constitute a viable screening tool both for women at high risk of breast cancer and for those at intermediate risk with high breast density. The stylet was removed, and the clear obturator was placed inside the white plastic introducer to assist in MRI confirmation of location. The obturator was identified on MRI as a low-signal focus measuring a median of 0.3 cm (range, 0.2–0.6 cm) in width. In our initial experience with a new method, the technical success rate of MRI-guided vacuum-assisted biopsy was 95%. The stylet was then placed through the needle guide in the appropriate orientation with the tip protruding only slightly from the far side of the needle guide, and the tip of the stylet was placed in the skin at the site of the scalpel incision before attaching the needle guide to the grid. The obturator was not placed inside the patient at this point, but rather measured to determine where to set the depth stop (Fig. Abstract. In the remaining six women, directed sonography was not performed at the discretion of the interpreting radiologist and treating clinician. 2019;213: 234-237. In one woman, the biopsy device could not be inserted because of hold-up of the white plastic introducer at the skin surface; the vacuum-assisted biopsy was aborted, and the lesion underwent needle localization and surgical excision. The complication was a clinical hematoma, evident as swelling with bluish discoloration immediately after biopsy. 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I), including one lesion that yielded benign findings at vacuum-assisted biopsy and a microscopic focus of atypical ductal hyperplasia at surgery. The depth (z-axis) coordinate of the lesion was determined on the basis of the relationship between the lesion and the skin surface. MRI-guided vacuum-assisted biopsy, pioneered by Sylvia Heywang-Kobrunner, has advantages compared with other biopsy methods for the diagnosis of MRI-detected lesions [25]. A leading journal selection tool is available free of charge for authors to find the best fit for their manuscript. American Journal of Roentgenology - Journal Metrics Imaging-Based Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Biopsy in Patients With Breast Cancer, Review. Citation: American Journal of Roentgenology. One woman at high risk for breast cancer who was 19 years old did not have a mammogram; in the remaining 19 women, mammographic parenchymal density [30] was class 4 (dense) in one, class 3 (heterogeneously dense) in 14, and class 2 (scattered fibroglandular densities) in four. The clip introducer was then pulled back slightly (≈2 mm), and the clip was deployed by pushing down on the handle. 10.2214/AJR.18.20396 Compared with fine-needle aspiration biopsy, vacuum-assisted biopsy has a higher technical success rate and fewer inadequate specimens [11, 15, 19–21]. In all instances of unsuccessful clip deployment, the collagen pledget was visible in the mouth of the biopsy handpiece after its removal; therefore, failure of clip deployment was immediately apparent to the radiologist performing the biopsy. The ability to perform biopsy quickly should improve accuracy. The biopsy was technically successful in 19 (95%) of 20 women. Targeting images.—The patient was positioned prone with both breasts in a dedicated surface breast coil (Open Breast Array Coil, model OBC, MRI Devices, Waukesha, WI). This case, therefore, may reflect a false-negative on the part of the MRI study rather than the biopsy procedure. The stylet was placed inside the introducer, advanced to the appropriate depth, and then removed, with the introducer remaining in position. The nipple, which enhanced at MRI, was excised without localization and yielded DCIS. Cancer was found at vacuum-assisted biopsy in six (22%) of 27 lesions. The protocol for this study was approved by our institutional review board. For the two lesions that were posterior to the grid, the skin incisions were made as close to the lesions as possible, posteriorly within the grid, and suction was applied in the posterior direction to acquire tissue. Therefore, the desired depth of insertion of the center of the collecting area (the “mouth”) of the vacuum-assisted biopsy probe from the outer aspect of the needle guide (in millimeters) was 20 plus z, where z was the calculated depth of the lesion (in millimeters) from the skin surface. The vacuum-assisted biopsy device is helpful for biopsy of posterior lesions. The American Journal of Roentgenology (AJR) is a monthly peer-reviewed journal that covers topics in radiology. SDC. Underestimates have been encountered with every existing percutaneous biopsy method. A beep was heard each time a specimen was acquired. A false-negative finding was defined as a lesion yielding benign results without atypia at vacuum-assisted biopsy and cancer at surgery. Among women with cancer in one breast, MRI detects additional sites of cancer in the ipsilateral breast in 6–34% [2] and detects an otherwise unsuspected cancer in the contralateral breast in 4–24% [3]. I. Thomassin-Naggara has provided remunerated lectures for GE Healthcare, Guerbet, Hologic, Canon, and Samsung and serves on advisory boards for Siemens Healthineers and Bard. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Preparing the probe.—The clear obturator was placed inside the white introducer, and the depth stop was set so that it was the appropriate distance from the tip of the clear obturator. However, “second-look” sonography fails to identify a sonographic correlate in up to 77% of MRI-detected lesions referred for biopsy [5–7]. MRI-guided breast biopsy is a challenging endeavor because of the requirement for specific MRI-compatible equipment, the need to remove the patient from the magnet to perform the biopsy, limited access to the medial and posterior breast, decreasing lesion conspicuity during the procedure (the “vanishing” target), needle artifact obscuring the lesion site, desirability of placing a localizing clip, and limitations in confirming lesion retrieval [8]. The study focused specifically on knee scans, and we are now working to extend the results to other parts of the body. The needle guide was oriented so that one of the holes would be in the appropriate location. Dibandingkan dengan Faktor Dampak historis, Faktor Dampak 2019 dari American Journal of Roentgenology turun 3.92 %. Of 98 consecutive women who had MRI-guided needle localization during the study period, 27 were invited to participate in the study, and 20 agreed to be included. 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