К стандарту описания маммограмм.

Катенёв Валентин Львович аватар
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В зарубежной литературе, в частности, Iowa Health Book: Diagnostic Radiology, рентгенологическая диагностика заболеваний молочной железы базируется на теневой картине, отражающейся в рентгенологических синдромах, представленных в таблице.

 

Таблица.

 

Breast, gland destruction –

изменённые участки структуры железы.

Изменение структуры железы, более четкое, чем в норме изображение, может быть при воспалительных заболеваниях железы.

Если эти изменения наблюдаются на отдельных участках железы, возникает подозрение на доброкачественную или злокачественную опухоль железы.

Breast vascular countur, prominent –

признаки нарушенного хода сосудов в железе.

В норме наблюдается правильный, упорядоченный ход сосудов железы. Нарушение сосудистого рисунка на отдельных участках может быть признаком мастопатии (доброкачественного образования железы) или злокачественной опухоли. Вопрос о природе опухоли решается с помощью биопсии ткани железы.

Breast microcalcifications - обнаружение микрокальцификатов (мелких очагов скопления кальция в ткани железы).

На маммограммах в норме нет вкраплений кальция. Наличие микрокальцификатов диффузное (распространенное) может быть результатом воспалительных изменений.

При обнаружении микрокальцификатов на ограниченных участках, возникает подозрение на опухолевый рост.

 

Катенёв Валентин Львович аватар
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Заключительная часть протокола, с учетом вышеизложенного представлена ниже.

Авторы предлагают формат заключений трех типов:

- нарушений структуры железы не выявлено (повторное исследование молочных желез назначается в плановом порядке);

- структура в основном нормальная, но некоторые участки вызывают сомнения (контрольное исследование назначается через 3 – 6 месяцев);

- есть подозрительные участки (назначается биопсия).

КОЛЛЕГИ! Ваше мнение?

Dr.Mario аватар
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Полный текст статьи:
(плагиат беру на себя. Но учитывая что источник указан, суд мы выиграем!)

BI-RADS Decoded: Detailed
Guidance on Potentially
Confusing Issues
Carl J. D’Orsi, MD*, Mary S. Newell, MD
The American College of Radiology (ACR) Breast


Imaging Reporting and Data System (BI-RADS) is the product of the initial collaboration between various committees of the ACR and several other organizations, such as the American College of American Pathologists and the American College of Surgeons. The impetus to establish a standardized method of reporting and follow-up began as early as 1985 when several of our clinical colleagues made a plea to the ACR to improve the reporting of mammograms. Reports were ambiguous and difficult to interpret, often leaving the clinician without a clear-cut management scenario. BI-RADS was always meant to be a dynamic and evolving document that would be able to adapt to changing practice patterns and new scientific data. Some of the initial articles concerning BI-RADS focused on determining the positive predictive value (PPV) of mammographic features and the effect of BI-RADS usage on clinical practice. Orel and colleagues [1] found upon pathologic evaluation of 1312 excised mammographic lesions that the PPV for malignancy was 0% for Category 2 (benign) lesions, 2% for Category 3 (probably benign) lesions, 30% for Category 4 lesions, and 97% for Category 5 lesions. Liberman and colleagues [2] analyzed 492 lesions detected only on mammography with subsequent surgical biopsy; PPVs were 2%, 34%, and 81% for Category 3, 4, and 5, respectively. Thus, the BI-RADS assessment categories seem to be separating breast disease appropriately. Berg and colleagues [3] investigated whether training could lead to observer improvement, with regard to mammographic feature analysis and final assessment when practicing radiologists were compared with the consensus of an expert panel. The expert panel reviewed a test set of cases, agreeing on feature description and analysis. Twenty-three practicing mammographers then reviewed these mammograms before and after a day of training with BI-RADS. There was an improved agreement with the expert consensus after training. Some specific areas, such as calcification distribution, did not show improvement, serving as an early indication that more detailed guidance was required to make successful use of BI-RADS.
Over the years of increasing BI-RADS usage, the BI-RADS committee of the ACR, now a subcommittee of the Breast Cancer Commission of the ACR, received questions which, when analyzed, focused on specific areas of BI-RADS. A review of these problematic areas, with appropriate guidance, is presented along with an introduction to the new ultrasound and MR imaging lexicons focusing on unique descriptors.

Mammography:


Focal asymmetry:

One of the most frequently asked questions relates to what constitutes an asymmetry versus a focal asymmetry versus a mass. A soft tissue finding identified only on one view, without matching tissue in a similar location in the contralateral breast, represents
an asymmetry. This is in contradistinction to focal asymmetries and masses, both of which are soft tissue findings seen on two views, lying at a comparable depth when one view is compared with another, and showing similar density and shape on those views. Focal asymmetries lack convex outward borders along at least a portion of their periphery on both views, whereas masses display consistent convex margins (Figs. 1 and 2). This distinction may be difficult at times; in general, though, although focal asymmetries may show partial border convexity, this feature usually is not noted in both mammographic views. Focal asymmetries are confined to a small area of the breast (within a quadrant), and may represent a subtle, but important, sign of malignancy (often an infiltrating lobular carcinoma), especially if seen to evolve over time (Fig. 3). Conversely, global asymmetries occupy a large portion of the breast (more than one quadrant). These asymmetries are usually on the basis of normal variation or secondary to the
effects of hormone replacement therapy. Note that the term ‘‘density’’ has been removed from the discussion of asymmetries because it is more accurately used as a descriptor of X-ray attenuation.

Fig.1

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Fig.2

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Fig.3

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Calcifications:


Detection and management of breast calcifications may be bothersome. Morphologies and distributions that typically are benign and those that are highly suggestive of malignancy usually offer little or no problem for management; however, there are shapes and distributions of calcifications that are difficult to detect, characterize, and manage.
Amorphous, fine pleomorphic, and coarse heterogeneous types of calcification may, at times, be troublesome to separate but can have different prognostic implications.‘‘Fine pleomorphic’’ calcifications are irregular, small (usually<0.5 mm) calcifications that, together with ‘‘fine linear’’ or ‘‘fine, linear branching’’ calcifications, have the highest probability for malignancy. ‘‘Amorphous’’ calcifications, arguably, may be the most problematic to identify. They also are small (<0.5 mm), irregular calcifications but differ from fine pleomorphic calcification in their conspicuity or density (Fig. 4). Their edges are not defined as sharply as are those in the fine pleomorphic category. They may present with only a slightly higher density than surrounding glandular tissue, accounting for their difficult detection. ‘‘Coarse heterogeneous’’ calcifications are a new addition to the fourth edition of BI-RADS. These calcifications also are irregular and conspicuous but basically differ from the prior two types in size. They generally are larger than 0.5 mm and are associated most often with benign conditions, such as fibrosis or fibroadenomas, but can be associated with malignancy (Fig. 5). Of the three types of calcifications described, fine pleomorphic are the most suspicious, coarse heterogeneous are the least suspicious, and amorphous are between the former and the latter. Berg and colleagues [4] reviewed 150 lesions that manifested as amorphous calcifications. Twenty percent were malignant and, of these, 90% represented ductal carcinoma in situ (DCIS). As a rule, it is unusual to have calcificationsthat are exclusively of one shape. Most are mixtures of different forms; however, it is the most worrisome of these forms that should direct subsequent management (Fig. 6). Although often not given as much attention as shape, the distribution of calcifications within thebreast often may allow separation into benign and malignant status with increased accuracy. The terminal duct lobular unit is the anatomic site of origin of most intraductal carcinomas (Fig. 7) [5].
When this concept is kept in mind, calcifications oriented in a ‘‘linear’’ or multiple linear (‘‘segmental’’) (Fig. 8) orientation assume greater importance,
even if the individual calcification shape is of intermediate concern. For example, linear or segmental arrangements of coarse heterogeneous calcifications are more worrisome than a regional distribution of the same calcifications. Grouped or clustered microcalcifications occupy less than 1 cm3 of tissue and are composed of at least five elements. This distribution is more lobular in nature and does not have the significance of a linear or segmental distribution. A cluster of coarse heterogeneous calcifications is less worrisome than a linear or segmental distribution; however, calcifications in
the category of higher probability of malignancy (pleomorphic and fine linear) almost always require tissue diagnosis, regardless of distribution.
As the distribution becomes less focal, as in ‘‘regional’’ (>2 cm3 of breast tissue not conforming to a duct and usually occupying a quadrant or more), or distributed randomly throughout the breast (‘‘diffuse/scattered’’), the suspicion for malignancy diminishes; however, one must act on the most worrisome feature or combination of features.

Fig.4

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Fig.5

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Fig.6

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Fig.7

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Fig.8

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Architectural distortion:


Another description that requires clarification is architectural
distortion. The hallmark of this feature is a series of thin, straight lines or spiculations radiating from an area (Fig. 9) that does not have features of a mass or focal asymmetry; however, these radiating spicules also may be identified from the edge of a mass or focal asymmetry (Fig. 10). In this situation, they become part of the margin description (‘‘spiculated’’) for the mass or asymmetry. Obviously, there are situations in which it becomes difficult or impossible to determine whether one is dealing with a speculated mass or architectural distortion; however, the presence of these radially oriented lines, whether originating from a mass, focal asymmetry, or a point, strongly suggest the presence of malignancy.

Fig.9

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Fig.10

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Assessment categories:


The assessment categories are arguably the most important component of the BI-RADS lexicon. Because they are coupled with management options, they categorize the mammogram and direct future management. Lehman and colleagues [6] reviewed the interpretation of 82,620 screening mammograms and compared the assessment categories and accompanying recommendations to determine if they were in accordance with BI-RADS guidelines. Overall discordance between category and management was low (3%); however, the assessment category with the highest discordance was ‘‘Category 3 – probably benign finding – initial short-term follow-up recommended,’’ at 54%. Thirty three percent of findings placed in Category 3 were managed by normal interval follow-up, 12% were managed with additional views, and 3.5% were managed with biopsy. It is important to underscore two points regarding findings assigned to this category. First, each finding should have less than a 2% chance of malignancy as confirmed by evidencebased literature [7–10]. This category is not the same as an indeterminate ranking that may be given for receiver operating characteristic curve analysis, which implies a relatively equal chance of a finding proving to be benign or malignant. The second important point is to assign findings to this category only after appropriate diagnostic workup. This also is true for Categories 4 and 5. Several studies [7–10] validated the principle of short-term follow up (Category 3) and demonstrated a malignancy rate ranging from 0.3% to 1.7%. Malignancies discovered subsequently in this category, secondary to change during the follow-up period, still carry a favorable prognosis. All investigators exclude the use of Category 3 for palpable lesions associated with probably benign findings; however, there are recent data [11] to suggest that palpable breast masses, benign in appearance at mammography and ultrasound, can be managed in a fashion similar to non palpable Category 3 lesions. In 108 patients with 112 lesions, no malignancy was found after a minimum of 2-year follow-up; however, these data must be validated with a larger series of patients. The reassignment of a finding from a probably benign category to a benign category requires more than the initial 6-month follow-up. Sickles [7] described a follow-up protocol for these findings that extended 3 to 3.5 years from initiation of an initial short-term follow-up. He found that all but one of the cancers was discovered by change that occurred within 2 years of follow-up (Fig. 11).

Fig.11

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A finding that is stable upon 2 years of follow-up is unlikely to represent a cancer, and at that time, the patient can be returned to Category 2 status. Because the experience and expertise of readers varies greatly, a finding placed into Category 3 by one reader may be changed to a Category 2 or 4 by a more experienced reader before the 2 years of follow-up. Category 0 originally was meant to indicate a recall from a screening mammogram for women requiring further imaging analysis; however, software vendors may include the request for a prior examination or a technical recall as Category 0. It is imperative to realize that these latter ‘‘recalls’’ should not be entered into an audit as a recall. Many users have questioned the use of Category 0 to request prior examinations. The request for prior examinations is not always required, especially when there are no findings of concern. In a study by Bassett and colleagues [12], prior films changed clinical management in approximately 3% of cases, showing little effect on cancer detection, but having a bigger impact on avoiding unnecessary recalls. In a more recent article by Roelofs and colleagues [13], the presence of prior mammograms helped in the analysis of questionable findings but had no effect on initial detection. This reinforces the request for prior studies only when the radiologist deems it necessary. Some users may prefer not to dictate a case for which prior films are required, but rather wait until they are received or not received in a predetermined time frame. This obviates separating this Category 0 from the audit; however, one must keep track of these cases to ensure that the report is sent out by the 30-day US Food and Drug Administration (FDA) limit, whether prior films are reviewed or not. Others prefer to dictate a report using Category 0 to indicate a request for prior films, which can be awkward when the software generates a clinical report; however, these studies are now entered into a mammography module and are easily tracked. If prior films are received, an additional ‘‘no charge’’ request can be made and another report generated indicating comparison to prior examinations. If no prior films are received, again a ‘‘no charge’’ request can be generated and appropriate findings can be evaluated with a second Category 0 assigned, which now relates to the need for a diagnostic workup rather than a request for prior examinations. With the advent of the MR imaging and ultrasound lexicons, Category 0 also may be used in a diagnostic setting, although this is done infrequently. One scenario may involve a screen/diagnostic center with no ultrasound or MR imaging capabilities. A finding may be evaluated fully by mammography but still require an MR imaging or ultrasound. This examination, although diagnostic, would receive a Category 0 for further imaging.
Categories 4, 5, and 6 are fairly straightforward but deserve some clarification. Category 4 may be subdivided into 4a (low suspicion for malignancy; Fig. 12), 4b (intermediate suspicion for malignancy; Fig. 13), and 4c (moderate concern but not classic for malignancy; Fig. 14). This new set of subdivisions addresses the fact that Category 4 encompasses a broad variety of findings, from complicated cysts at one extreme to irregular indistinct masses at the other extreme, with a consequent uncomfortably broad range in likelihood of malignancy (3% to 94%).

Fig.12

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Fig.13

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Fig.14

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By subdividing Category 4, internal audits will be more precise, research is facilitated, and clinically, physicians will understand that these subdivisions deliver different rates of malignancy and are not surprised if biopsy of a Category 4a finding yields a benign diagnosis. In a recent publication by Lazarus and colleagues [14], validation of the subdivisions was demonstrated. Ninety-four lesions were analyzed, and a pathologic diagnosis was available for all. The PPV for Category 4a, 4b, 4c, and 5 were 6%, 15%, 53%, and 91%, respectively. One important caveat to remember is the unofficial nature of these subdivisions. These are suggested and are for internal use only. If you wish to include them on the official report, the FDA mandates that the standard Category 4 language be present (‘‘suspicious abnormality – biopsy should be considered’’); however, it may be amended by the previously mentioned subdivisions.
For example, if a complicated cyst is recommended for aspiration, the assessment may properly state: ‘‘Category 4 – suspicious abnormality – biopsy should be considered, 4a – low suspicion for malignancy.’’ The report, however, may not read ‘‘Category 4a – low suspicion for malignancy – cyst aspiration recommended.’’ Although the latter assessment may make more sense, it will take up to3 to 4 years to undergo the FDA approval process to incorporate these subdivisions into regulation. At first, Category 5 seems to be redundant. This category was developed at the request of surgical members of the first BI-RADS committee and was meant to define lesions with at least a 95% chance of malignancy, for which a one-stage surgical procedure without prior biopsy could be considered. This category should be reconsidered at this point, because the original intent of its inclusion may not be as widely applicable today. Category 6 is reserved for biopsy-proven malignancy before definitive therapy and is not used for audit purposes. If a facility performs a study for a second opinion that has a biopsy-proven malignancy but an additional finding requiring further imaging is identified, this case should receive a BI-RADS 0 and not a BI-RADS 6 assessment. If the only finding on the second-opinion examination is the known biopsy-proven malignancy, then a BI-RADS Category 6 assessment is appropriate.
The BI-RADS committee is actively discussing management and coding issues not covered directly in the fourth edition of BI-RADS. One question that many users have identified is ‘‘Which BI-RADS category should be assigned when a palpable mass is present but imaging is negative?’’ BI-RADS is an imaging lexicon and if imaging is negative, even in the face of a clinical finding, the examination should be coded as ‘‘Category 1 – negative.’’ Obviously, direction regarding further management of the clinical finding should be included in the report. For example, a notation that the area of clinical
concern should be dealt with independently from the mammogram may be included. The scenario becomes a little more complicated when a palpable and imaging finding coincide. The imaging finding should drive the management category. Thus, if a simple cyst is seen at the site of a clinical finding, it would be a Category 2 for imaging; however, the clinician may opt to aspirate the cyst clinically.
Another problematic area concerning coding and management is detection of findings that are not part of the breast, but are seen on breast-imaging studies. For example, one may detect bilateral axillary adenopathy. How is this coded? Is it ignored? The BI-RADS committee is in the process of discussing the options available, ranging from an additional assessment category to use of existing categories. For example, using existing categories, if there is a known benign reason for the adenopathy (eg, sarcoid, rheumatoid arthritis), this may be coded as a BI-RADS Category 2. If further imaging is required (eg, ultrasound, MR imaging), this may be a Category 0. If biopsy is needed, a Category 4 can be used; if the woman has a known lymphoma or leukemia, a Category 6 can be used.
With this scenario, the coding depends much more on the combination of the history and the imaging findings. The BI-RADS committee also is discussing breast density. There is evidence in the literature that mammographic accuracy may range from 98% in fatty breasts to as low as 64% to 70% in dense breasts [15–17]. To provide a better sense of the amount of fat and glandular tissue present, which affects sensitivity and is an independent risk factor for malignancy, consideration of using more precisely defined percentages of fibro-glandular tissue, within the current broad density categories, is under consideration. ‘‘Almost entirely fat’’ would be up to and including 10% density, instead of the current range of 0% to 25%.‘‘Scattered fibro-glandular densities’’ might then range from 11% to 50% density but could be subdivided into two categories: 11% to 25% density might be described as ‘‘few scattered areas’’ and 26% to 50% as ‘‘moderate scattered areas.’’ ‘‘Heterogeneously dense’’ currently is defined as 51% to 75% glandular, but modifiers may be added to describe where the densest area resides (eg, dense tissue located anteriorly or in the upper outer quadrants). ‘‘Extremely dense’’ would remain at 76% to 100%. Although these changes may be construed as unnecessary, the relative amounts of fibro-glandular tissue and fat define mammographic sensitivity, may be helpful in the medico legal arena, and may facilitate research concerning the risk for malignancy related to mammographic density.
This exercise may not be necessary after the widespread adoption of digital mammography.
Computer programs are being developed that are able to analyze pixel gray levels and then determine the percentage of fibro-glandular tissue by dividing the number of dense pixels by the total number of pixels. This technique was used to compare radiologists’ estimates of breast density with that of a computer [18]. The computer-generated estimate compared favorably with the radiologists’ estimates of percent-density; however, more interesting and important was the superior reproducibility of the computer program with little overlap of the categories, as occurred with the qualitative assessment of the radiologists.


Audit:


Although the audit section is fairly straightforward, some points of clarification deserve mention. The major metrics used for a breast audit (sensitivity, specificity, and PPV) all use true positive (TP), false positive (FP), true negative (TN), and false negative (FN) terminology. A positive mammogram is one that receives BI-RADS 0, 4, or 5, whereas a negative mammogram is one coded as 1, 2, or 3. Note again that Category 6 and Category 0 for prior studies or technical reasons are omitted for audit purposes. If cancer is found within a year from the mammogram, this is proof of malignancy; when no cancer is found in that same period, this constitutes no evidence for malignancy. Thus, BI-RADS 0, 4, or 5 with confirmation of cancer within the year represents a TP; lack of discovery of cancer is a FP. A BI-RADS assessment of 1, 2, or 3 with no cancer found within the year is a TN; if cancer is found, this is an FN. This is the foundation for all of the metrics described for auditing a practice.

Addition to the fourth edition of BI-RADS:

An ultrasound and MR imaging lexicon have been added to the fourth edition of BI-RADS. With the advent of multiple lexicons, which may be used for a single patient, the features most associated with malignancy should influence the BI-RADS category chosen. Because most, if not all, radiologists involved with breast imaging are using a computer- based dedicated tracking module, it is important to realize the hierarchy of the assessments as they relate to immediate, intermediate, or routine action. This understanding will be helpful when using all three lexicons within a computer-based breast-imaging module. Categories 5, 4, and 0 require immediate action and will be ordered from the most to least chance of malignancy in computer modules (ie, 5, 4, 0). Category 3 indicates intermediate action (6-month initial short-term follow-up) and Categories 1 and 2 are routine. Thus, the hierarchy that all of the lexicons will use is 5, 4, 0, 3, 2, and 1, from the highest to the lowest possibility for malignancy and from findings requiring immediate action to examinations needing only routine action. Although there may be many scenarios that could arise when intertwining the lexicons on a single patient, some examples may help to clarify this association. A woman may come for a diagnostic mammogram because of the presence of a palpable mass; the mammogram workup views are negative, but the ultrasound done on the same day shows an irregular solid mass. When using all of the lexicons, the final code would be ‘‘Category 4, biopsy suggested.’’ This would be the patient’s final management category and would appear on the report, whether or not the palpable mass coincides with the ultrasound finding. If there is no imaging finding in the area of clinical concern this can be handled by a statement indicating that the area of clinical concern should be managed independently of the imaging examinations. Thus, even though a Category 1 assessment would be appropriate for the mammogram because these modules are hierarchical in nature, only the most worrisome would be coded for that patient (ie, Category 4 for the ultrasound instead of Category 1 for the mammogram). A problem arises when an imaging examination is negative but another imaging examination is needed. For example, a diagnostic mammogram for a woman with implants demonstrates a contour change on an implant. This should be a ‘‘0’’ and perhaps ultrasound requested to determine if there is capsular rupture not identified on the mammogram.
If the ultrasound examination is negative, it should be given a Category 1; however, MR imaging would be the next logical imaging examination. This can be handled in the body of the report by stating that although ultrasound is negative, an MR imaging is more precise to identify intracapsular rupture. In this way, correct imaging codes are given, and the additional imaging is recommended in the report. The problem here is because Category 1 is entered with the ultrasound examination, there is no way to record or remind the patient and clinician of the requested MR imaging examination. We could use Category 0 for the ultrasound and request MR imaging. In this way, it would be recorded in the computer and reminders could be sent out automatically until the outstanding ‘‘0’’ is closed by the assessment from the MR imaging examination; however, the ultrasound examination is negative and does not fit with the associated recommendation. These points are being addressed actively by the BI-RADS committee. For the present, it is probably better to assess such examinations based on their imaging findings and explain in the report the need for any other imaging examination. Ultrasound/MR imaging lexicons. This final section focuses on some of the features that are unique to ultrasound and MR imaging. ‘‘Background echotexture’’ is the sonographic term that best corresponds to mammographic density. A homogeneous echotexture may be composed almost entirely of fat lobules or echogenic tissue (ie, fibroglandular). A heterogeneous echotexture is a mixture of these echogenicities. Echogenicity is described using fat in the subdermal layer of the breast as an internal reference and as the midpoint between hypo- and hyperechoic. Findings with greater echogenicity are hyperechoic, those with a similar echogenicity are isoechoic, and those with less echogenicity are hypoechoic. Findings with no echogenicity are anechoic. In general, anechoic and hyperechoic masses are benign, whereas hypoechoic masses may represent benign or malignant findings. Masses that contain anechoic and fixed (hyper- or hypo-) echogenic components are termed complex masses (Fig. 15).

Fig.15

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Masses with a mixture of movable internal echoes and interspersed anechoic areas are termed complicated cysts. At times, it may be difficult to differentiate a complicated cyst from a hypoechoic mass. The ultrasound properties posterior to a mass, as well as its orientation, are important to realize and comment upon. If there is an increase in echogenicity directly posterior to a mass compared with the adjacent posterior tissues, this is an indication that the energy of the sound beam has been maintained passing through the mass, producing posterior acoustic enhancement. This is seen frequently in cystic lesions. The reverse is true when the sound beam passes through a solid mass with many energy-absorbing interfaces, producing a weaker beam behind the mass, which is displayed as acoustic shadowing. A mass that is taller than it is wide is more suspicious than one that is wider than it is tall (nonparallel versus parallel orientation) (Fig. 16).

Изображение
Breast MR imaging adds physiologic information in the form of vascular flow to that of morphology. Basically, MR-sensitive contrast agents are used to enhance T1-weighted signals. This enhancement is in proportion to the increased vessel density and leakage of contrast from abnormal tumor vessels, which do not contain all of the layers of normal vessels. Thus, the unique terminology here relates to signal enhancement after the use of contrast agents. The enhancement within a mass may be homogenous (uniform enhancement) or heterogeneous  (non uniform). Within the heterogeneous group, there is mass enhancement that may be preferentially in the periphery (rim) (Fig. 17) or have nonenhancing septations, or have central enhancement.

Fig.17

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Enhancement also may be non mass-like, with a distribution terminology similar to that of calcification distributions. A focal area of enhancement occupies less than 25% of a quadrant. Linear enhancement is enhancement in a line but not definitely in a ductal distribution (Fig. 18), whereas ductal enhancement also is linear but points toward the nipple and may have branching.

Fig.18

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Segmental enhancement is triangular in shape, with its apex pointing toward the nipple. Regional enhancement involves a large volume, whereas diffuse or scattered enhancement is distributed uniformly throughout the breast. The enhancement within these distributions may be homogeneous, stippled (small punctate) (Fig. 19), clumped (cobblestone- like) (Fig. 20), or reticular (strand-like).

Fig.19

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Fig.20

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Another unique enhancement feature relates to the intensity of enhancement of a mass or region over time. The faster the enhancement of a mass or area and the faster that the increased signal later disappears (washout), the more worrisome is the finding for malignancy.
Thus, proper understanding and use of the ACR BI-RADS will promote the generation of standardized, clear, clinically useful reports and will facilitate breast-imaging research by allowing reproducible comparison of nationally and internationally collected data.

 

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Катенёв Валентин Львович аватар
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Суда не будет - мы их "пошлём".

Dr.Mario аватар
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Катенёв Валентин Львович wrote:

Суда не будет - мы их "пошлём".

 

СмеюсьСмеюсьПоказываю язык

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Необходимо отметить, что в настоящее время нет единодушного мнения, по поводу так называемых «микрокальцинатов». Л.Д. Линденбратен указывает, что данным термином обозначаются кальцинаты менее 1 мм.

 

 А.Г. Илькевич считает, что микрокальцинатом должен называться кальцинат размерами менее 0,5 мм. Другие авторы, также не единодушны в характеристике микрокальцинатов по величине.

 

Некоторые авторы пользуются классификацией микрокальцинатов по M. Le Gal, которая предусматривает деление микрокальцинатов на 5 типов:

 

Тип1. Круглые и дуговидные кальцинаты, иногда горизонтальные или полулунные, соответствуют маленьким микрокистозным эктазиям.

Тип 2. Круглые, правильной формы.

Тип 3. Пылевидные, очень нежные.

Тип 4. Точечные, неправильной формы.

Тип 5. Червеобразные, древовидные. Отражают внутрипротоковый некроз.

Dr.Mario аватар
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Залил изображения в статью; нелёгкая это работа!
Валентин Львович, я вам ответил по вашему посту Маммография на http://radiographia.ru/node/1000#comment-1391
Простите что раньше не видел.

Let me see...

radiographia.ru

Евгений Магонов аватар
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Эх, подставляете Вы меня, доктор Марио!

Спасибо за столь большую работу. В наших целях я думаю, это нельзя считать плагиатом Спокойный Надеюсь, ругательных писем не получим.

Добрый админ

Катенёв Валентин Львович аватар
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Чтобы не получать ругательные письма, можно просто не читать писем.

Rg-Doc аватар
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Что нам суд? Мы же русские. Спокойный Но по этой же причине (мы русские), мне довольно тяжело оценить ценность статьи представленной уважаемым Dr. Mario. Хмурый

Катенёв Валентин Львович аватар
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