2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recommended for women with an approximately 20-25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.57.2.75

American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

ContextDietary patterns and lifestyle factors are associated with mortality
from all causes, coronary heart disease, cardiovascular diseases, and cancer,
but few studies have investigated these factors in combination.ObjectiveTo investigate the single and combined effect of Mediterranean diet,
being physically active, moderate alcohol use, and nonsmoking on all-cause
and cause-specific mortality in European elderly individuals.Design, Setting, and ParticipantsThe Healthy Ageing: a Longitudinal study in Europe (HALE) population,
comprising individuals enrolled in the Survey in Europe on Nutrition and the
Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands,
Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women,
aged 70 to 90 years in 11 European countries. This cohort study was conducted
between 1988 and 2000.Main Outcome MeasuresTen-year mortality from all causes, coronary heart disease, cardiovascular
diseases, and cancer.ResultsDuring follow-up, 935 participants died: 371 from cardiovascular diseases,
233 from cancer, and 145 from other causes; for 186, the cause of death was
unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence
interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91),
physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65;
95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality
(HRs controlled for age, sex, years of education, body mass index, study,
and other factors). Similar results were observed for mortality from coronary
heart disease, cardiovascular diseases, and cancer. The combination of 4 low
risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44).
In total, lack of adherence to this low-risk pattern was associated with a
population attributable risk of 60% of all deaths, 64% of deaths from coronary
heart disease, 61% from cardiovascular diseases, and 60% from cancer.ConclusionAmong individuals aged 70 to 90 years, adherence to a Mediterranean
diet and healthful lifestyle is associated with a more than 50% lower rate
of all-causes and cause-specific mortality.

https://jamanetwork.com/journals/jama/articlepdf/199485/JOC32767.pdf

Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women: The HALE Project

is a common complication after treatment for breast cancer. Factors associated with increased risk of lymphedema include extent of axillary surgery, axillary radiation, infection, and patient obesity. 2,3 The panel recommends educating the patients on lymphedema, monitoring for lymphedema, and referring for lymphedema management as needed.”

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines

Breast imaging reporting and data system (BI-RADS).

Should we undertake an MRI breast screening trial? – Authors' reply

Objective: To assess the performance of a computer-assisted diagnosis (CAD) software in detecting pulmonary embolism (PE) on multidetector computed tomography (MDCT). Methods: MDCT angiography data of 100 consecutive patients with clinically suspected PE were retrieved. Diagnosis (initial read) had been made in consensus by two out of 10 radiologists. The original data were transferred to a CAD software, and two other experienced chest radiologists reviewed all CAD markings to determine the ground truth for CAD and the standard of reference (final diagnosis) in consensus. The markings were categorised as true or false positive. For true positive, the involved vessel segment was classified as lobar, segmental, and subsegmental. Sensitivity, specificity, and negative and positive predictive values of initial and CAD diagnoses were compared. Results: In the initial read, 27 and 73 patients were positive and negative for PE, respectively. Based on the standard of reference, five (6.9%) of the 73 patients negative for PE were determined to be false negative and the remaining 68 were true negative. The CAD software marked 86 and 14 patients with and without pulmonary emboli, respectively. Based on the standard of reference, 26 were true positive, 57 were false positive, 11 were true negative, and 6 were false negative. The CAD software detected pulmonary emboli in five (6.9%) of 73 patients who were initially read as negative, but failed to detect pulmonary emboli in six (22.2%) of 27 patients who were initially read as positive. Respectively for the initial read and CAD software, sensitivity was 84% and 81%, specificity was 100% and 16%, positive predictive value was 100% and 31%, and negative predictive value was 93% and 65%. Conclusions: The CAD software can be a second reader but should not be used as a stand-alone tool for diagnosis; all MDCT should be reviewed by a radiologist.

Computer-assisted Diagnosis of Pulmonary Embolism in Multidetector Computed Tomography

Content-based image retrieval (CBIR) provides novel options to access large repositories of medical images. Thus, there are new opportunities for storing, querying and reporting especially within the field of digital radiology. This, however, requires a revisit of nomenclatures for image classification. The Digital Imaging and Communication in Medicine (DICOM), for instance, defines only about 20, partly overlapping terms for coding the body region. In 2002, the Image Retrieval in Medical Applications (IRMA) project has proposed a mono-hierarchic, multi-axial coding scheme. Although the initial concept of the IRMA Code was designed for later expansion, the appliance of the terminology in the practice of scientific projects discovered several weak points. In this paper, based on a systematic analysis and the comparison with other relevant medical ontologies such as the Lexicon for Uniform Indexing and Retrieval of Radiology Information Resources (RadLex), we accordingly propose axes for medical equipment, findings and body positioning as well as additional flags for age, body part, ethnicity, gender, image quality and scanned film. The IRMA Code II may be used in the Cross Language Evaluation Campaign (CLEF) annotation tasks as a database of classified images to evaluate visual information retrieval systems.

IRMA Code II

Simple Summary The clinically relevant information that guides further surgical management of the axilla in women with breast cancer is the distinction between non-significant (N0–N1) versus significant (≥N2) lymph node metastases. In women with newly diagnosed breast cancer, MRI is increasingly used to determine the local extent of disease in the breast. The aim of our retrospective study on 414 patients who underwent routine breast MRI for local staging of the breast was to determine whether an abbreviated protocol for regional lymph node staging is sufficient to identify patients with significant nodal disease. Our results demonstrated that a single 3 min coronal T1-weighted sequence, acquired with the system’s built-in body coil, covering the chest wall, axilla, and supra- and infraclavicular region, helped rule out the presence of significant nodal disease with a NPV of 98.8% [97.0–100%]. False-positive findings were mostly caused by patients with positive, but non-significant, lymph node metastases (N1). Abstract Background: The detection of regional lymph node metastases (LNM), in particular significant LNM (≥N2), is important to guide treatment decisions in women with breast cancer. The purpose of this study was to determine whether a coronal pulse sequence as part of pre-operative breast MRI is useful to identify women without significant LNM. Material: Retrospective study between January 2017 and December 2019 on 414 consecutive women with breast cancer who underwent pre-operative breast MRI on a 1.5 T system. For lymph node (LN) staging, a coronal pre-contrast non-fat-suppressed T1-weighted TSE sequence was acquired with the system’s built-in body coil, covering the chest wall; acquisition time 3:12 min. Two radiologists rated the likelihood of LNM on a 3-point scale (absent/possible/present). Validation was obtained by histology from sentinel LN biopsy, axillary LN dissection, and/or PET/CT. Results: 368/414 women were staged to have no or non-significant LNM (pN0 in 282/414, pN1 in 86/414), and significant LNM (≥pN2) in 46/414. For identification of women with significant LNM, MRI was true-positive in 42/46, false-negative in 4/46, true-negative in 327/368, and false-positive in 41/83, the latter mostly caused by women with N1-disease (38/41), yielding an NPV and PPV for significant LNM of 98.8% [95%-CI: 97.0–100%] and 50.6% [43.1–58.1%], respectively. Conclusions: A 3 min coronal T1-weighted pulse sequence covering the chest wall as part of pre-operative breast MRI is useful to rule out significant LNM with high NPV. Where MRI staging is positive for significant LNM, additional work-up is indicated to improve the distinction of N1 and N2 disease.

/pdf/abbreviated-mri-for-comprehensive-regional-lymph-node-1ibq9d77.pdf

Abbreviated MRI for Comprehensive Regional Lymph Node Staging during Pre-Operative Breast MRI

[This corrects the article DOI: 10.1371/journal.pone.0155717.].

/pdf/correction-positive-contrast-mri-techniques-for-6fw9z2x8m1.pdf

Correction: Positive Contrast MRI Techniques for Visualization of Iron-Loaded Hernia Mesh Implants in Patients.

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