technique, and the limitations of diffusion tensor imaging and anisotropic

diffusion-weighted MRI are presented and their applications in various

neurological and neurosurgical diseases are discussed with special emphasis

on the visual system. A special focus is laid on the combination of fiber tract

imaging, anatomical imaging, and functional MRI for presurgical planning

and intraoperative neuronavigation of lesions near the visual system.

Orbital pathology

Muller-Forell W, Pitz S. (Institute for Neuroradiology, Medical School

University of Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany). Eur

J Radiol 2004;49:105–142.

This overview of orbital pathology deals with different kinds of tumors,

inflammatory, vascular, and traumatic diseases, which may involve the

orbit. Depending on the respective orbital compartment of the globe, the

intrakonal, extrakonal, and optic nerve, the most important and most

frequent lesions are presented with their specific clinical symptoms. Their

specific presentation on CT and MR imaging is discussed in detail,

including the most important differential diagnosis.

Intracranial pathology of the visual pathway

Muller-Forell W. (Institute of Neuroradiology, Medical School University of

Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany). Eur J Radiol

2004;49:143–178.

Intracranial pathologies involving the visual pathway are manifold. Align-

ing to anatomy, the most frequent and/or most important extrinsic and

intrinsic intracranial lesions are presented. Clinical symptoms and imaging

characteristics of lesions of the sellar region are demonstrated in different

imaging modalities. The extrinsic lesions mainly consist of pituitary

adenomas, meningiomas, craniopharyngiomas, and chordomas. In (asymp-

tomatic and symptomatic) aneurysms, different neurological symptoms

depend on the location of aneurysms of the circle of Willis. Intrinsic tumors

as astrocytoma of any grade, ependymoma, and primary CNS lymphoma

require the main pathology in the course of the visual pathway. Vascular

and demyelinating diseases complete this overview of intracranial lesions.

Mammographic features of breast cancer in young symptomatic

women

Zadelis S, Houssami N. (N.H.: Screening and Test Evaluation Program

(STEP), School of Public Health, A27, University of Sydney, New South

Wales 2006, Australia). Australas Radiol 2003;47:404–408.

The present study provides a descriptive analysis of the mammographic

appearance of breast cancer in women aged 30–39 years presenting with

symptoms, based on 65 cancers confirmed with histology. We correlate the

findings with clinical presentation and histological findings. We describe,

categorize and illustrate the different lesions seen on mammography. Our

study shows that microcalcification, with or without associated masses, is a

dominant feature of breast cancer visualized on mammography in women in

this age group.

Value of three-dimensional helical CT image-guided planning for

made-to-order lumpectomy in breast cancer patients

Uematsu T, Sano M, Homma K, Sato N. (Division of Diagnostic Radiology,

Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka 411-8777, Japan).

Breast J 2004;10:33–37.

The authors reviewed Niigita Cancer Center Hospital’s experience treating

patients with lumpectomy to evaluate the utility of three-dimensional

helical computed tomography (3D-CT) image-guided made-to-order lum-

pectomy and determine a positive margin rate. From April 1993 to

September 2000, 251 breasts in 248 patients were treated with lumpectomy

with a 1-cm macroscopic free margin. In 213 breast (85%), 3D-CT image-

guided made-to-order lumpectomy was performed. Thirty-eight breasts

(15%) underwent a lumpectomy without 3D-CT. The lumpectomy spe-

cimen was sectioned at 5-mm intervals. Margin status was classified as

negative (no invasive or ductal carcinoma in situ (DCIS) within 2 mm from

the cut surface) or positive. Positive margins were classified as focally

positive (invasive or DCIS transected at the margin within 5 mm or one

slide) or massively positive. With 3D-CT image-guided lumpectomy, 21%

(45/213) of lesions had a positive margin and 42% (16/38) of lesions

without 3D-CT image-guided lumpectomy had a positive margin

( P= .0055). For lesions with massively positive margins, the rates were

9% (4/45) for 3D-CT image-guided lumpectomy and 38% (6/16) for

lumpectomy without ( P= .0152). 3D-CT image-guided made-to-order

lumpectomy decreased the positive surgical margin rate. Among patients

with positive margins, those with 3D-CT image-guided lumpectomy have

less residual cancer than those without 3D-CT.

Comparison of MRI and renal cortical scintigraphy findings in

childhood acute pyelonephritis: preliminary experience

Kovanlikaya A, Okkay N, Cakmakci H, Ozdogan O, Degirmenci B,

Kavukcu S. (H. C.: Department of Radiology, Dokuz Eylul University

School of Medicine, Inciralti, Izmir, Turkey). Eur J Radiol 2004;49:76–80.

Objective: The diagnosis of acute pyelonephritis in children remains a

clinical challenge. It may cause permanent renal scar formation and results

in the chronic renal failure if prompt diagnosis and treatment are delayed.

The purpose of this study is to compare magnetic resonance imaging (MRI)

and renal cortical scintigraphy (RCS) findings in childhood acute pyelo-

nephritis and to determine pyelonephritic foci in the acute phase.

Materials and methods: Twenty children (15 females and 5 males) with

symptoms dysuria, enuresis, costovertebral pain, fever of 37.5 �C or more,

and/or positive urine culture were imaged by unenhanced turbo spin echo

T2, spin echo T1-weighted, and pre- and postgadolinium inversion recovery

MRI and RCS. Both imaging techniques were read independently by two

radiologists and nuclear medicine specialists. Sensitivity and specifity of

MRI in detecting in detecting acute pyelonephritic foci and scar lesions

were calculated. Furthermore, in order to calculate the reliability of MRI

over RCS in differentiating scar tissue and acute pyelonephritic foci,

follow-up MRI studies were done in six patients after treatment of acute

pyelonephritis.

Results: Sensitivity and specificity of MRI in the detection of pyeloneph-

ritic lesions were found to be 90.9 and 88.8%, respectively. There is no

statistically significant difference in lesion detection between the two

diagnostic modalities ( P > .05).

Conclusion: Postgadolinium MR images show significant correlation with

RCS in the determination of renal pathology. Moreover, the ability of

discriminating acute pyelonephritic foci and renal scar in early stages of

disease is the superiority of MRI.

T2-weighted MR imaging of prostate cancer: multishot echo-planar

imaging vs. fast spin-echo imaging

Tamada T, Sone T, Nagai K, Jo Y, Gyoten M, Imai S, Kajihara Y,

Fukunaga M. (Department of Radiology, Kawasaki Medical School, 577

Matsushima, 701-0192 Kurashiki City, Okayama, Japan). Eur Radiol 2004;

14:318–325.

The aim of the present study was to assess the performance of prebiopsy

T2-weighted MR imaging using multishot echo-planar imaging (EPI)

sequence for visualization of prostate cancer and to compare image quality

with that of fast spin-echo (FSE) sequence. Thirty-nine patients with

Abstracts / Journal of Clinical Imaging 28 (2004) 231–233232