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american journal of roentgenology fastmri

Sinopsis

10.2214/AJR.18.21007 The protocol was to obtain at least six specimens. MRI sequences performed after completion of tissue acquisition were reviewed for 26 lesions; in one lesion these images were not available because of magnet malfunction. In two of these three lesions, MRI review indicated that the clip had deployed deep in relation to the biopsy site; in the third, the clip was at the biopsy site, but the wire had migrated superficially, perhaps because it was not firmly anchored in the biopsy cavity. The median time to perform MRI-guided vacuum-assisted biopsy, from the original axial localizing images to the final images obtained after clip deployment, was 35 min (mean, 35 min; range, 24–48 min) for a single lesion and 65 min (mean, 69 min; range, 62–86 min) for two lesions. Gadopentetate dimeglumine, 0.1 mmol/L per kilogram of body weight, was injected IV as a rapid bolus injection through an indwelling IV catheter, and acquisition of sagittal images (3-mm slice thickness) started immediately after contrast injection. MRI review suggested that the MRI target may have been excised at vacuum-assisted biopsy in three of these cancers (two DCIS and one infiltrating lobular carcinoma) and was sampled at vacuum-assisted biopsy in five. A skin nick was made with a scalpel. SUBJECTS AND METHODS. A leading journal selection tool is available free of charge for authors to find the best fit for their manuscript. Obtaining a two-view mammogram after biopsy is essential to assess location of the clip with respect to the biopsy cavity. The front end of the probe was placed back into the introducer. Previous studies have reported technical success rates of 61–100% for MRI-guided fine-needle aspiration [11, 15, 19–21], 33–100% for MRI-guided automated core biopsy [12, 15, 22–24], and 93–98% for MRI-guided vacuum-assisted biopsy [25, 28]. A false-negative finding was defined as a lesion yielding benign results without atypia at vacuum-assisted biopsy and cancer at surgery. The obturator was not placed inside the patient at this point, but rather measured to determine where to set the depth stop (Fig. 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. 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-guided needle localization.—After MRI-guided vacuum-assisted biopsy and clip placement had been completed, MRI-guided needle localization was performed using previously described methods [17] with an MRI-compatible hookwire (MReye Modified Kopans Spring Hook Localization Needle [20-gauge], Cook, Bloomington, IN). The diagnosis of atypical ductal hyperplasia at percutaneous biopsy is an indication for surgical excision [32]. The mammogram obtained after biopsy confirmed a 3-cm soft-tissue mass with air, consistent with the clinically evident hematoma. MRI-Guided Vacuum-Assisted Breast Biopsy Performed at 3 T With a 9-Gauge Needle: Preliminary Experience, Accuracy of MRI in the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy, Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience. 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. Frequency was in the anteroposterior direction. The sixth cancer was a 0.7-cm mass in which the imaging target may have been excised at MRI-guided vacuum-assisted biopsy, and histologic analysis of vacuum-assisted biopsy specimens yielded infiltrating lobular carcinoma; the surgical specimen showed fibrosis and changes related to prior biopsy, with no residual carcinoma (Fig. Publication End Year. Citation: American Journal of Roentgenology. 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]. The ability to perform biopsy quickly should improve accuracy. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. Biopsy of suspicious MRI-detected lesions is necessary for definitive diagnosis. Underestimates have been encountered with every existing percutaneous biopsy method. Keywords: abbreviated, breast, cancer, MRI. The clip was then placed inside the probe as far as it would go (Fig. This study was performed to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. History The direction of tissue acquisition was determined by the radiologist performing the biopsy by turning the arrow on the biopsy probe in the desired direction. Histologic underestimation was observed in one lesion. Specimen radiography showed retrieval of the localizing wire, but the clip was not identified. The American Roentgen Ray Society, founded in 1900, is the first and oldest radiology society in the United States. Compared with fine-needle aspiration biopsy, vacuum-assisted biopsy has a higher technical success rate and fewer inadequate specimens [11, 15, 19–21]. 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]. The ability to position the vacuum-assisted biopsy device adjacent to the lesion and still acquire tissue from the lesion is another advantage of vacuum-assisted biopsy over automated core biopsy [32]. The monthly American Journal of Roentgenology is a highly respected peer-reviewed journal with a worldwide circulation of close to 25,000. Continued by AJR, American journal of roentgenology Title varies: 1906-Sept. 1913, American quarterly of roentgenology; Nov. 1913-1922, The American journal of roentgenology; 1923-51, The American journal of roentgenology and radium therapy 14 Addeddate 2009-09-28 23:30:49 Call number AAX-2787 Camera Four of eight cancers were identified in women undergoing MRI for the assessment of disease extent (multifocal cancer in the ipsilateral breast in two, multicentric cancer in the ipsilateral breast in one, and contralateral cancer in one), and four were detected in women who are at high-risk for breast cancer undergoing MRI for screening. In the remaining six women, directed sonography was not performed at the discretion of the interpreting radiologist and treating clinician. 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 indication for breast MRI in these 20 women was assessment of disease extent in women with known cancer diagnosed within 6 months of breast MRI in 10 and screening of women who are at high-risk for breast cancer in 10. 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 Journal Impact 2019-2020 of American Journal of Roentgenology is 3.190, which is just updated in 2020. 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. Biopsy of lesions detected only on MRI is most often performed with MRI-guided needle localization for surgical biopsy. In one (4%) of the 27 lesions, a 5.0-cm non–mass lesion sampled at vacuum-assisted biopsy, vacuum-assisted biopsy histology revealed markedly atypical ductal hyperplasia and lobular carcinoma in situ (LCIS); surgical excision showed markedly atypical ductal hyperplasia focally reaching the level of low-grade cribriform DCIS, arising in a background of florid mammary sclerosing adenosis and columnar cell changes, as well as extensive LCIS (Fig. We found that if the lesion was close to but posterior to the grid, we could position the probe adjacent to the lesion and use the suction to acquire tissue in the posterior direction, enabling us to obtain diagnostic material. Some non-North American radiologists think that AJR stands for the American Journal of Radiology; however, it has always been short for the American Journal of Roentgenology, or a close variant of this. Section thickness was between 2 and 3 mm without a gap using a matrix of 256 × 192 and a field of view of 18–22 cm. The median number of specimens obtained per lesion was eight (range, 6–14). Specimen radiography, performed in 23 lesions in which the clip was placed, confirmed retrieval of the localizing clip in 22 (96%). Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. The clinical study to be published in the American Journal of Roentgenology demonstrates that fastMRI’s AI model does indeed produce images that are just as accurate, useful, and reliable as those from a standard MRI. 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. In these cases, the clip and collagen pledget fell back into the mouth of the biopsy device and did not deploy in the breast. 1A) by one of three attending radiologists specializing in breast imaging. In one smooth mass that yielded fibroadenoma at vacuum-assisted biopsy, a mammogram obtained after biopsy showed that the clip was 4.0 cm deep (medial) in relation to the lesion. About AJR. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. The skin surface was identified as the slice on which the indentations from the grid were evident as low-signal-intensity lines. If you use the fastMRI data or this code in your research, please consider citingthe fastMRI dataset paper: Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. The vacuum-assisted biopsy device is helpful for biopsy of posterior lesions. The stylet was placed inside the introducer, advanced to the appropriate depth, and then removed, with the introducer remaining in position. A T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (17/2.4; flip angle, 35°; bandwidth, 31.25 MHz) was then performed before and three times after a rapid bolus injection of 0.1 mmol/L of gadopentetate dimeglumine (Magnevist, Berlex, Wayne, NJ) per kilogram of body weight, delivered through an indwelling IV catheter. The patient was then withdrawn from the magnet with her breast remaining in compression. Those results represent the culmination of nearly two years of open research by FAIR and NYU Langone Health, which is a group of academic medical centers in New York City. The median size of the MRI lesions in these eight cancers was 1.1 cm (range, 0.6–6.5 cm). 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. 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. This method provides an alternative to surgery and to existing MRI-guided needle biopsy methods in clinical use for histologic diagnosis of MRI-detected lesions. 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. The direction of tissue acquisition was chosen on the basis of the location of the introducer with respect to the lesion. The vacuum-assisted biopsy device used in our study allows rapid acquisition of multiple specimens, deferring specimen collection until after tissue acquisition is complete. After tissue acquisition was complete, the biopsy device was removed, the obturator was reinserted, and sagittal T1-weighted images (3-mm slice thickness), the postexamination images, were obtained to assess the completeness of tissue acquisition. For more than 100 years the AJR has been recognized as one of the best specialty journals in the world. This time is faster than prior reports of MRI-guided needle biopsy: in the largest series to date, average time to perform biopsy was 60 min for MRI-guided fine-needle aspiration [11], 60 min for MRI-guided automated core biopsy [23], and 70 min for MRI-guided vacuum-assisted biopsy [28]. The protocol for this study was approved by our institutional review board. The Journal Impact of an academic journal is a scientometric Metric that reflects the yearly … A separate skin incision was made for each lesion that underwent biopsy. 2019;213: 234-237. A new clinical study to be published in the American Journal of Roentgenology shows for the first time that fastMRI images are interchangeable with those of regular MRIs. Kuartil Faktor Dampak American Journal of Roentgenology adalah Q1 . A faster biopsy also enables increased throughput in the magnet and is more comfortable for the patient. The depth of the skin surface from the outer aspect of the needle guide was 20 mm (because the needle guide was 2-cm thick). 2019;213:485-489. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. Placing the device and imaging to confirm its location.—A mark was made on the skin overlying the lesion, and the skin was cleansed with alcohol and anesthetized with 3–8 mL of 1% lidocaine hydrochloride (Xylocaine [10 mg/mL], AstraZeneca, Wilmington, DE). The radiologist performing the biopsy reviewed MRIs obtained during and after biopsy to determine the presence and extent of postbiopsy changes (e.g., hematoma or air); to assess whether the MRI target was sampled or possibly excised; and to evaluate whether the localizing clip was visible, noting any problems with visualization of the clip. Vacuum-assisted biopsy also facilitates placement of a clip that can be used for subsequent needle localization [33]. In four (17%) of 24 lesions the radiologist noted that differentiating the clip from low-signal foci representing air was difficult, but could be accomplished by comparing images before and after clip placement. The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24–48 min). For MRI-detected lesions that can be seen on sonography, biopsy can be performed under sonographic guidance. 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. In approximately one quarter of lesions (23%), cancer was found at MRI-guided vacuum-assisted biopsy. The study shows that fastMRI can generate “diagnostically interchangeable” MRI images of knee injuries while using about 75 percent less raw data from the … The results of the study ("Using Deep Learning to Accelerate Knee MRI at 3T: Results of an Interchangeability Study"), were published in the American Journal of Roentgenology. This procedure helped to ensure that the biopsy device entered through the incision site, even when that site was later obscured by the needle guide. The goal of the ARRS is maintained through an annual scientific and educational meeting and through publication of the American Journal of Roentgenology, … OBJECTIVE. The median maximal distance from the clip to the localizing wire was 0.6 cm (range, 0.1–4.1 cm). Surgical histologic analysis showed fibroadenoma, other benign findings, and biopsy site changes. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. Compared with automated core biopsy, vacuum-assisted biopsy retrieves a large volume of tissue, which can help compensate for decreasing lesion conspicuity during MRI-guided biopsy, and provides better characterization of lesions containing atypical ductal hyperplasia and DCIS [32]. Outcome of MRI-Guided Breast Biopsy, Original Research. Although it remains controversial, excision may also be warranted for lesions yielding LCIS at percutaneous biopsy [35]. Since less data is required, MRI scans could run nearly 4x faster. Musculoskeletal radiologists reviewed 2 sets of knee MRIs from 108 patients, 1 set using the standard imaging techniques and 1 set using the fastMRI AI model. 5A, 5B, 5C): the reported sensitivity of MRI for DCIS has ranged from 40% to 100% [37]. Further work with more women is necessary, including optimization of equipment and techniques for biopsy and clip placement, potential use of long-acting contrast agents, imaging–histologic correlation, and long-term follow-up, so that we can offer women the benefits of MRI in detecting breast cancer while minimizing surgeries for lesions that are benign. 3A, 3B, 3C). In 23 lesions, only a single round of tissue acquisition was necessary; in four lesions, MRI after the first round of tissue acquisition did not ensure lesion sampling, and a second round of tissue acquisition was performed. 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. SDC. Our anecdotal impression is that turning the biopsy device so that it faces downward (6-o'clock position) during clip deployment, removing the clip's introducer after clip deployment, and then removing and inspecting the biopsy handpiece to ensure that the clip deployed were helpful. 1D). The four screening-detected cancers were in two women: one woman with bilateral breast cancer and one woman with multifocal invasive breast cancer. ... Official journal of the American Roentgen Ray Society, 1976- and the American Radium Society, 1976-1980. online access Articles in this collection are free and open access. A clip can enable subsequent localization under the guidance of mammography (or sonography, if it is sonographically evident). A vitamin E marker was placed over the expected lesion site (Fig. A paper written by the team describing the new technology is to be published in the American Journal of Roentgenology. A sagittal T1-weighted MRI study (3-mm slice thickness) was then performed to document the location of the obturator, with the ideal location of the tip of the obturator being at the site of the lesion. Vacuum-assisted biopsy and surgical histology were correlated. When the biopsy device was fully inserted into the white introducer, the center of the mouth was positioned where the tip of the obturator had been. MRI was performed after clip deployment in 24 lesions; in one woman with two lesions, MRI was not performed after clip deployment because of magnet malfunction. Like many of the more long-lived academic publications, there have been a number of name changes over the years (see below). 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. 1B). 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. The faster the biopsy is accomplished, the less likely that the lesion will move. Frequency and Cancer Yield of BI-RADS Category 3 Lesions Detected at High-Risk Screening Breast MRI, Review. High risk lesions such as atypical ductal hyperplasia and LCIS will very likely be more prevalent at percutaneous biopsy in women having breast MRI because they are at high risk for breast cancer than in the general population [36]. The American Journal of Gastroenterology. The American Journal of Roentgenology (AJR) is a monthly peer-reviewed journal that covers topics in radiology. United States. Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Address correspondence to L. Liberman ([email protected]). Publication Frequency. Opinion. It is published by the American Roentgen Ray Society (ARRS) and is based in Leesburg, VA. In that instance, sampling of a large lesion with MRI-guided biopsy yielded markedly atypical ductal hyperplasia and LCIS, whereas subsequent surgical excision revealed DCIS. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4–6.4 cm). 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. 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. Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). The median size of these 27 lesions was 1.0 cm (range, 0.4–6.4 cm). The median time for a round of tissue acquisition was 38 sec (mean, 41 sec; range, 29–87 sec). Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). The study focused specifically on knee scans, and we are now working to extend the results to other parts of the body. 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) For MRI-detected lesions warranting biopsy, correlative sonography was performed at the discretion of the radiologist interpreting the MRI study; if a sonographic correlate was identified, biopsy or localization was usually performed under sonographic guidance. The clip introducer was then pulled back slightly (≈2 mm), and the clip was deployed by pushing down on the handle. American Journal of Roentgenology is a peer-reviewed scientific journal. Predictors for Failing the American Board of Radiology Core Examination Gary Lloyd Horn , Stephen Herrmann , Irfan Masood , Clark R. Andersen , Quan Dang Nguyen American Journal of Roentgenology . Get Content & Permissions Free. Update on Breast Density, Risk Estimation, and Supplemental Screening, Review. The society has been a forum for progress in radiology since shortly after the discovery of the X ray and is dedicated to the goal of the advancement of medicine through the science of radiology and its allied sciences. 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). Faktor dampak atau faktor pengaruh atau faktor dampak jurnal dari suatu jurnal akademik adalah ukuran yang mencerminkan jumlah rata-rata sitiran (sitasi) tahunan untuk artikel terbaru yang dipublikasikan … Immobilizing the breast without excessive compression may be helpful during MRI-guided biopsy to maximize breast thickness, avoid interfering with lesion enhancement [28], and minimize the “accordion effect” described with clip placement [33]. Address correspondence to I. Thomassin-Naggara (, Original Research. CONCLUSION. A complication was encountered in one (4%) of 27 lesions and in one (5%) of 19 patients. 115(12):1989-1997, December 2020. In this series, authors of select AJR articles discuss how their studies were performed, the results, and how the studies changed their practices. 1E). Informed consent, preparation before the biopsy, biopsy equipment, and radiologists.—Informed consent was obtained for all biopsy and needle localization procedures. Among these 27 lesions, quadrant location was upper outer quadrant in 11, lower outer quadrant in 11, upper inner quadrant in four, and lower inner quadrant in one. Perhaps use of a clip with more artifact or using different pulse sequences would help to assess clip location on MRI. 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. In spite of these challenges, investigators have reported clinical experience with MRI-guided needle localization for surgical excision [4, 9–18] and MRI-guided percutaneous biopsy using a fine needle [11, 15, 19–21], automated core needle [12, 15, 22–24], or vacuum-assisted biopsy probe [25–29]. We thank the 20 women who enrolled in the study for making this work possible. For more than 100 years the AJR has been recognized as one of the best specialty journals in the world. One complication was encountered, a hematoma that resolved with compression. Screening Guidelines Update for Average-Risk and High-Risk Women. Van Zee 2 and Lee K. Tan 3 ... American Journal of Roentgenology. American journal of roentgenology. Seventeen were mass lesions and 10 were non–mass lesions. Health and Facebook teamed up to launch the fastMRI initiative two years ago in a with... 3.92 % Andrew B. Rosenkrantz are correlated in Table 1 MRI-detected lesions can also be performed under sonographic.! 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Histology are correlated in Table 1, other benign findings, and Supplemental Screening Review!, other benign findings, and ensuring hemostasis is important is faster, less invasive, and less than. 3-Mm slice thickness ) american journal of roentgenology fastmri then placed inside the probe was placed inside the,... Study is larger than the 11-gauge systems most commonly used for subsequent needle localization and DCIS! Should improve accuracy that resolved with compression and did not delay subsequent surgery on breast Density, Estimation... Malignant lesions is necessary Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Staging and Sentinel Node! Were mass lesions and in one ( 5 % ), and then needle localization procedures,! All AJR articles on COVID-19 Thomassin-Naggara (, Original Research Axillary Lymph Node biopsy in six ( %... Women: one woman with multifocal invasive breast cancer yielded DCIS the holes be! 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Were being acquired, the Metric 2019 of American Journal of Roentgenology found... Lesions, technical Innovation three contrast-enhanced acquisitions, was excised without localization and yielded DCIS nipple, enhanced.

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