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Myocardium, Pericardium, and Cardiac Tumor

Pericardium Anatomy The pericardium can be thought of as two layers of a deflated balloon, which is wrapped around the heart. One side of that balloon becomes the inner layer (visceral layer), which is wrapped around and closely adheres to the heart and the overlying epicardial fat and coronary arteries. The outer layer (the parietal layer) of the balloon is embedded into the surrounding structures, namely…

Coronary Heart Disease

Coronary artery disease is by far the leading cause of mortality and morbidity in the western world. The impact of coronary heart diseases and related atherosclerotic conditions like stroke, in terms of reduced quality of life, life-years lost, and direct and indirect medical costs, remains enormous. Clinical Manifestations of Coronary Artery Disease Stable Coronary Artery Disease In stable coronary artery disease, atherosclerotic plaques accumulate in the…

Cardiac Computed Tomography

Cardiac computed tomography (CCT) has become a mainstream imaging tool for the assessment of coronary atherosclerosis and changes resulting from pericardial, valvular, and myocardial heart disease. Computed tomography (CT) use had always been limited by relatively long acquisition time and poor spatial resolution to identification of abnormal calcification, or the observation of incidental findings, such as pleural or pericardial effusion. The introduction of spiral multidetector CT…

Cardiac Magnetic Resonance Imaging

Cardiac magnetic resonance (CMR) imaging provides high-spatial and temporal resolution imagery from which reproducible morphologic and functional information can be obtained for the evaluation and management of patients with cardiovascular disease. Substantial progress in the design and application of new pulse sequences has pushed CMR into the mainstream of noninvasive cardiac diagnosis. CMR is already considered the procedure of choice for quantitation of myocardial mass and…

Echocardiography

Echocardiographic Examination Two-Dimensional Transthoracic Examination During the routine echocardiography examination, a fan-shaped beam of ultrasound is directed through a number of selected planes of the heart to record a set of standardized views of the cardiac structures for subsequent analysis. These views are designated by the position of the transducer, the orientation of the viewing plane relative to the primary axis of the heart, and the…

Introduction to Cardiac Imaging

Roentgen’s discovery of x-rays was immediately translated into a clinical imaging tool, visualizing previously invisible internal organs, including the heart and great vessels. Correlation of early descriptions of abnormal cardiac shape and size with clinical examination and (all too frequently) autopsy findings demonstrated the accuracy and clinical utility of fluoroscopic and plain film imaging in patients with cardiac disease. Pathologic changes visualized in these studies reflected…

MRI-Guided Breast Biopsy

When a suspicious finding is seen on a breast magnetic resonance imaging (MRI) examination and other imaging and clinical examinations are negative, the only way to perform a biopsy of the lesion is by using MRI guidance. All facilities that perform breast MRI should have the ability to perform MRI-guided biopsy. If it is not offered, patients must go elsewhere for the procedure, adding time, inconvenience,…

MRI for Breast Implant Evaluation

More than 2 million women in the United States have undergone breast implantation since the 1960s, either for cosmetic augmentation or breast reconstruction. During this time, both the silicone controversy and the known complications of breast augmentation have necessitated an accurate imaging modality to evaluate breast implants. Magnetic resonance imaging (MRI) has become the accepted standard for the evaluation of implant integrity. In this chapter, we…

MRI of the Postoperative Breast

The breast undergoes significant anatomic and histologic changes after intervention. Posttreatment imaging findings have been thoroughly described for mammography and breast ultrasound, but only isolated descriptions of postsurgical breast changes seen on dynamic contrast enhanced (DCE) breast magnetic resonance imaging (MRI) are found in the literature. New or recurrent cancer can be difficult to detect in the postsurgical breast by physical examination, breast ultrasound, and mammography.…

MRI Evaluation of the Patient with Breast Cancer

In the absence of distant metastatic disease, breast cancer staging is based on the extent of local-regional disease in the breast and axilla. The American Joint Committee on Cancer TNM system is used to provide breast cancer patients and their clinicians criteria for determining prognosis and treatment options. The TNM system categorizes extent of disease using anatomic data from the primary tumor (T), regional lymph nodes…

MRI of High-Risk Breast Lesions

Some benign pathologic entities of the breast, when diagnosed at image-guided core needle biopsies, have the potential to be upgraded to invasive carcinoma or ductal carcinoma in situ (DCIS) upon complete excision by surgery. These entities are collectively categorized as high-risk lesions and include atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), papillary lesions, radial scar, phyllodes…

Benign Findings in Breast MRI

The current practice of breast imaging calls for using breast magnetic resonance imaging (MRI) only on high-risk patients with appropriate indications to maximize cancer detection yield and minimize the false-positive rate. Even with careful selection of patients, radiologists usually encounter benign findings more frequently than malignant lesions when interpreting breast MRI. It is important for radiologists to be familiar with these benign findings because it will…

MRI Features of Invasive Disease

Breast magnetic resonance imaging (MRI) has become an important part of the work-up of patients with newly diagnosed breast cancers. Although no large studies have proved a survival advantage, and questions remain as to whether preoperative MRI has reduced re-excision and recurrence rates, the potential benefit of preoperative MRI cannot be questioned. MRI can identify foci of invasive disease with greater sensitivity than mammography or sonography,…

MRI Features of Ductal Carcinoma in Situ

Ductal carcinoma in situ (DCIS) now makes up 20% to 30% of newly diagnosed breast cancers, an increase in detection that is largely attributed to the advent of screening mammography. Before the advent of screening mammography, DCIS made up about 5% of breast cancers. DCIS is defined as intraductal malignancy that does not extend beyond the basement membrane, and therefore—at least theoretically—has no propensity to metastasize.…

Screening for Breast Cancer with MRI

Breast cancer remains the second leading cause of cancer death in women. Mammography is the single large-scale method currently employed in screening for breast cancer in asymptomatic women. Although the effect of mammography in decreasing mortality is debated, multiple studies have shown its efficacy, particularly in patients aged 50 to 69 years. But mammographic imaging has limitations, including patient exposure to ionizing radiation and low sensitivity,…

Computer-Aided Detection for Breast MRI

Optimal breast magnetic resonance imaging (MRI) interpretation depends on the image reader’s ability to both detect and accurately characterize contrast enhanced breast lesions. Detecting areas of enhancement involves the tedious process of comparing the precontrast and postcontrast sequences. This process can be facilitated with subtraction images; however, even a small amount of patient motion can degrade subtraction images, limiting their utility. Once an abnormality is detected,…

Optimizing the Breast MRI Protocol

Optimizing the breast magnetic resonance imaging (MRI) protocol requires many decisions to be made about image acquisition techniques, types of pulse sequences, and sequence parameters used to control image quality and acquisition speed. Fundamental trade-offs exist among spatial resolution, acquisition speed, and signal-to-noise ratio, and these trade-offs must be understood in order to optimize quality and speed consistent with diagnostic goals. Image contrast is controlled by…

Setting Up and Optimizing a Breast MRI Practice

Breast magnetic resonance imaging (MRI) was introduced into the breast imaging community in the 1990s. A considerable number of research studies were conducted, with findings revealing promising results Breast MRI provided a novel approach to detecting breast cancer and diagnosing additional unsuspected breast lesions alongside the standard mammography technique. Implementation of breast MRI now was being considered by facilities as an additional imaging modality. Published breast…

18 F-FDG PET/CT and Nuclear Medicine for the Evaluation of Breast Cancer

Since its introduction in the early 1990s as a promising functional imaging technique, positron emission tomography (PET) and subsequently PET combined with computed tomography (PET/CT), has gained widespread acceptance in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment, and radiotherapy planning. PET is a sensitive and specific noninvasive technology used to depict the whole-body distribution of positron-emitting biomarkers.…

Clinical Breast Problems and Unusual Breast Conditions

Various breast symptoms and clinical problems are encountered in both benign breast conditions and breast cancer. This chapter briefly describes these conditions and elucidates how to distinguish them from malignancy. The Male Breast: Gynecomastia and Male Breast Cancer The incidence of breast cancer in males is rare, constituting less than 1% of all breast cancers in the United States, so usually the symptoms for which men…