Breast Lympoma

An article to describe the Imaging findings in breast lymphoma with inputs on XRay mammography, USG, MR and Pet CT. Read it at http://http://radiology.rsnajnls.org/cgi/content/abstract/245/3/692

CT Enteroclysis-- how to do it

Read this very lucid article on CT enteroclysis using negative and positive oral contrast material. It's in the recent edition of Radiology-- full text can be viewed at IRIA HQ. The abstract is available at http://http://radiology.rsnajnls.org/cgi/content/abstract/245/3/661?etoc

Imaging & Pathology of Accessory Ossicles and Sesamoid Bones

A lot of us may have forgotten all about accesory ossicles and sesamoid bones. here's a refresher course from Applied Radiology. Read the article at http://http://www.medscape.com/viewarticle/564711

64 slice CTA in diagnosis of acute chest pain

Read this article on d/d of acute chest pain . Read it at http://www.medscape.com/viewarticle/551970_print

UAE for symptomatic adenomyosis

Read this state-of-the-art article on uterine artery embolization for symptomatic adenomyosis. Read all of it from the AJR at http://http://www.medscape.com/viewarticle/551971_print

From the streets of Italy to Nobel Prize

Read this inspiring article about Mario Carpecchi's journey from the streets of Italy to win the Nobel prize for Medicine. Read it all at http://www.medscape.com/viewarticle/564215_print

Stroke Imaging

This is cutting edge stuff on the use of modern imaging techniques in stroke. Check it out at http://www.medscape.com/viewarticle/560812_print

Alzheimer's Disease-- new diagnostic criteria

Check out this article if you are intersted in early diagnosis of AD. See it at: http://www.medscape.com/viewarticle/559761?src=mp

Balo's concentric sclerosis

A good descriptive case with pointers on how to distinguish it from MS. See it on: http://www.medscape.com/viewarticle/558577?src=mp

MRI contrast safety issues

After 17 years and millions of patients being administered IV MR contrast the US FDA has issued a stern black-box warning on the contrast agents warning about the possible potential danger of developing NSF in renal compromised patients. Is this justified? Dr. Semelka writes a good critique of the situation at http://www.medscape.com/viewprogram/6746_pnt

Medical radiation Exposure management

Check out this article on managing patients who have had multiple diagnostic tests involving ionizing radiation on http://www.medscape.com/viewarticle/555093_print

Radiologist India: Musings on Cancer

Radiologist India: Musings on Cancer
http://www.medscape.com/viewarticle/553795?src=sr

Musings on Cancer

When somebody as evocative as Robert Chevrier of Medscape writes about dealing with dreaded cancer, the result brings tears to your eyes-- a poignant moment for Medscape. Please read this article- it may change your approach to cancer patients. read it at http://www.medscape.com/viewarticle/553795?src=sr

Mammography MR vs X-ray

Read tis excelent review advocating the use of X-Ray mammography over MRI and the situations where the reverse is warranted. This review is by Dr. Subhash Ramani, Addl. Prof. of Radiology at Tata Memorial Hospital.

Read on:-

Hi Folks,

I have been reading the recent reports on Breast MRI better etc, etc in News paper to which I have send an appropriate letter!

I recently came across the write up in - Inner Spaces.

I would like to put things in correct perspective:

The American Cancer Society guidelines Published in the March/April 2007 available at CA: A Cancer Journal of Clinicians specifies that breast MRI screening should only be used with certain groups of high-risk women, such as BRCA mutation carriers and those with a family history of breast cancer. The guidelines do not recommend MR for women at average risk, those with very dense breasts, or those who already have had breast cancer, including ductal carcinoma in situ (DCIS). The ACS Breast Cancer Advisory Group said there is not enough evidence to support MR in this population because of the modality's tendency toward false-positive results.

The ACS also says that breast MRI should be used with conventional mammography as part of an annual screening regimen in certain groups of women. The other article published in the New England Journal of Medicine March 29, found that breast MRI had good sensitivity, specificity, and negative predictive value, and in some cases detected contra lateral breast cancer that was missed with mammography and clinical examination. In a related editorial, Dr. Robert A. Smith, from the American Cancer Society in Atlanta, comments that it may be argued that the added sensitivity of MRI of the contra lateral breast comes at high cost in terms of false-positive results and over diagnosis.

There is no organized breast cancer screening program in India . Screening mammography needs extensive quality assurance and controls at various levels, which is lacking in India. It is only since the last few years that AERB(India) has made it mandatory to have all mammography units to be prototype approved!

None of the professional organizations that advocate Screening mammography support sonography for screening like American College of Radiology, & FDA.

There are anecdotal reports of breast sonography picking up additional cancers not detected by mammography, and such statements/ claims about the effectiveness of breast sonography - breast screening - are not supported by the medical literature. While anecdotal evidence supports the effectiveness of finding additional cancers by breast sonography, clinical studies have failed to support such claims!

All alternative breast imaging modalities are insufficient for detecting cancer and are not a viable replacement for biopsy, according to a report(2006)released by the Agency for Healthcare Research and Quality (AHRQ). AHRQ is a division of the U.S. Department of Health and Human Services.

Each of the four (non invasive) tests -- magnetic resonance imaging, ultra sonography, PET, and scinti mammography -- would miss a significant number of cases of cancer, for women who receive abnormal findings from a mammogram or physical exam.

All four tests would miss between 4% to 9% of cancers among women with an abnormal mammogram & biopsy remained the most effective technique for revealing any potential for cancer.

Regards

--
Dr Subhash K Ramani.
Additional Professor & Asst Radiologist.
(Resource Person Mammography)
Tata Memorial Hospital.
Dr E Borges Raod, Parel,
Mumbai 400012.India.
Tel: 24171761(Off).
Fax: 009122-24146937

CAD in Computed Mamography

The use of computer aided detection software in interpretation of computed mammograms has received a body-blow from a study in the prestigious NEJM which points out the decreased sensitivity and large number of false positives using CAD. Read all about this on http://www.auntminnie.com/index.asp?Sec=sup&Sub=adv&Pag=dis&ItemId=75304&wf=1798&d=1

CAD in Computed Mamography

The use of computer aided detection software in interpretation of computed mammograms has received a body-blow from a study in the prestigious NEJM which points out the decreased sensitivity and large number of false positives using CAD. Read all about this on http://www.auntminnie.com/index.asp?Sec=sup&Sub=adv&Pag=dis&ItemId=75304&wf=1798&d=1

Restricting screening breast mammograms

The American college of Physicians has recommended a case by case approach to screening mammography examination for women in their 40's. Read all about it on http://www.auntminnie.com/index.asp?Sec=sup&Sub=wom&Pag=dis&ItemId=75260&wf=1792

MRI contrast and NSF

Check out the latest literature on nephrogenic systemic fibrosis folowing MR contrast media administration. A review presented by Aunt Minnie at http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=75171&wf=1754

CT assessment of myocardial viability

Myocardial viability after MI may be best assessed by 64-slice CT-- the authors used CT done 24 minutes after CCTA to assess hyperenhancement of the myocardium and assess myocardial viability. Read it all on http://www.auntminnie.com/index.asp?Sec=sup&Sub=mri&Pag=dis&ItemId=75049&wf=1737

Also read how 1.5T and 3T MRI are equivalent for assessing myocardial viability-- read about it on http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=75042&wf=1737

Biological hazards of Radiation revisited

Another CME summarizing and making sense of all the hoopla over radiation hazards from diagnostic ionizing radation. Read all about it on http://www.medscape.com/viewprogram/5063

Prenatal screening for Down's syndrome

New guidelines for pre-natal screening for Down's syndrome recommend screening of all patient's for Down's syndrome-- this was earlier restricted by gynaecologists to only those mothers conceiving after the age of 35 years. Read about it on http://www.medscape.com/viewarticle/550256?sssdmh=dm1.245214&src=top10#

Non-invasive accurate diagnosis in Alzheimer's disease

FDNNP-PET, FDG PET and MRI have shown that FDNNP PEt is the most accurate for diagnosis of Alzheimer's disease, binding to plaques and tangles. This is one of the most significant breakthroughs in neuro-imaging, because it enables us to evaluate AD non-invasively, whereas a confirmed diagnosis was earlier possible only using MRI as a screening tool with biopsy confirmation. Read all about it at http://www.medscape.com/viewarticle/549894?sssdmh=dm1.245214&src=top10#

Doppler in erectile dysfunction

A long hard look at doppler evaluation in erectile dysfunction from the Journal of Impotence research-- state-of-the art stuff here, very good overview. Check it out on http://www.medscape.com/viewarticle/550323_print and http://www.medscape.com/viewarticle/550324_print

Nephropathic effects of Gadolinium

Bad news for those who thought CEMRI and MRA was safe in patients with renal failure. Gadolinium was found to be associated with patients developing nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy (NSF/NFD). Check out the details on http://www.medscape.com/viewarticle/550122?src=mp