Automated breast ultrasound (ABUS) is an ultrasound technique that tends to be increasingly used as a supplementary technique in the evaluation of patients with dense glandular breasts. Patients with dense breasts have an increased risk of developing breast cancer compared to patients with fatty breasts. Furthermore, for this group of patients, mammography has a low sensitivity in detecting breast cancers, especially if it is not associated with architectural distortion or calcifications. ABUS is a standardized examination with many advantages in both screening and diagnostic settings: it increases the detection rate of breast cancer, improves the workflow, and reduces the examination time. On the other hand, like any imaging technique, ABUS has disadvantages and even some limitations. Many disadvantages can be diminished by additional attention and training. Disadvantages regarding image acquisition are the inability to assess the axilla, the vascularization, and the elasticity of a lesion, while concerning the interpretation, the disadvantages are the artifacts due to poor positioning, lack of contact, motion or lesion related. This article reviews and discusses the indications, the advantages, and disadvantages of the method and also the sources of error in the ABUS examination.

The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve’s quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound.

Ziel: Ziel der Studie war die Bewertung des Einflusses technischer Parameter und/oder von Läsionscharakteristika auf den endgültigen Elastografie Score solider Mammaknoten. Material und Methoden: Eingeschlossen wurden Patientinnen mit soliden Brusttumoren die im Zeitraum von Mai 2007 bis Mai 2008 in der Radiologischen Abteilung der Universtity of Medicine and Pharmacy, Cluj-Napoca untersucht wurden. Alle Läsionen wurden mit konventionellen Ultraschall, Doppler Ultraschall und Sonoelastografie entsprechend einem voreingestellten Protokoll untersucht. Der Einfluss folgender Parameter auf den Elastografie Score wurde untersucht: Schnittbildrichtung (sagittal versus transversal); Größe der Region of Interest (klein versus groß), Amplitude und Frequenz der Bewegung; initiale Komprimierung (gering versus stark); Angulierung (senkrechte versus angulierte Sondenposition); Läsionscharakteristika (Größe und Lokalisation). Referenz war die histopathologische Diagnose und, in 20 Fällen, das Kurzzeit Follow-up. Ergebnisse: Zweiundneunzig Patientinnen mit einem mittleren Alter von 48,11 Jahren und 101 Mammaknoten wurden in die Studie eingeschlossen. Insgesamt lag die Sensitivität und die Spezifität der Elastografie bei 79 % [68 – 88 %] bzw. 79 % [65 – 89%] mit einem negativ prädiktiven Wert von 74 % [60 – 85 %] und einem positiv prädiktiven Wert von 84 % [72 – 91 %]. Die folgenden Parameter hatten keinen Einfluss auf den Elastografie Score: Schnittbildrichtung (Scores bei transversaler und longitudinaler Schnittrichtung, Z = -0,641, p = 0,552); die Amplitude und Frequenz der Bewegung während der elastografischen Untersuchung (Cochran's Q Konkordanz = 0,706, p = 0,872); starke initiale Komprimierung im Falle benigner Läsionen (Z = 0,000, p = 1,000); Größe der Läsion. Neun der elastografisch benignen Knoten waren falsch negativ und von 46 elastografisch malignen Knoten waren 12 falsch positiv. Die folgenden Parameter hatten Einfluss auf den Elastografie Score: Größe der Region of Interest (die Scores waren signifikant unterschiedlich bei der Auswahl großer im Vergleich zu kleinen Regions of Interest, Z = –0,671, p < 0,0001); Schallkopf Angulierung (Z = –5,42, p < 0,0001); starke initiale Komprimierung im Falle maligner Läsionen (Z = –6,044, p < 0,0001) und die Lokalisation der Läsion in der Nähe der Brustwand. Schlussfolgerung: Die wichtigsten Parameter, die den endgültigen Elastografie Score beeinflussen und zu falsch negativen Ergebnissen führen, sind die Größe der Region of Interest und die initiale Komprimierung und Angulierung des Schallkopfes. Dem entgegen hatten die Frequenz und die Amplitude der Bewegung während der Untersuchung keinen Einfluss auf das Ergebnis, so lange die Bildgebung zweckmäßig durchgeführt wurde. Änderung der Schallparameter führte bei malignen Mammaläsionen nie zu falsch positiven Ergebnissen. Purpose: The aim of the study was to assess the influence of technical factors and/or lesion characteristics on the final elastographic score in solid breast nodules. Materials and Methods: Patients with solid breast masses examined between May 2007 and May 2008 in the Radiology Department of Cluj District University Hospital were included in the study. All lesions were examined with conventional ultrasound, Doppler ultrasound and sonoelastography, according to a preset protocol. The influence of the following factors on the elastographic score was evaluated: type of section (sagittal versus transverse); size of region of interest (small versus large); amplitude and frequency of movement; initial compression (light versus strong); angulation (perpendicular versus angulated transducer); characteristics of the lesion (size and location). The reference diagnosis was the histopathology diagnosis and, in twenty cases, short-term follow-up. Results: Ninety-two patients with a mean age of 48.11 years and 101 breast nodules were included in the study. The overall sensitivity and specificity for elastography were 79 % [68–88 %] and 79 % [65 – 89 %], respectively, with a negative predictive value of 74 % [60–85 %] and a positive predictive value of 84 % [72–91 %]. The following factors did not influence the elastographic score: type of section (scores on transverse and longitudinal section, Z = –0.641, p = 0.552); the amplitude and frequency of movements during the elastographic examination (Cochran’s Q concordance = 0.706, p = 0.872); strong initial compression in the case of benign nodules (Z = 0.000, p = 1.000); size of the lesions. Of the elastographically benign nodules, 9 were false negative and of the 46 elastographically malignant nodules, 12 were false positive. The following factors influenced the elastographic scores: size of the region of interest (the scores were significantly different when small or large region of interest was used, Z = –0.671, p < 0.0001); transducer angulation (Z = –5.42, p < 0.0001); strong initial compression in the case of malignant nodules (Z = –6.044, p < 0.0001) and the location of the mass in the vicinity of the chest wall. Conclusion: The most important factors that influence the final elastographic score, leading to false negative results, are the size of the region of interest, the initial compression and angulation of the transducer, while the frequency and amplitude of movement during the examination proved to be of no importance as long as the images were obtained within a range of assessment usefulness. Changing the scanning parameters never led to false positive results in the case of malignant breast masses.

Perineural spread (PNS) represents the tumor’s ability to disseminate along nerves. The aim of this article is to review the relevant literature about the PNS in head and neck tumors (H&N). The important information for imaging analysis is summarized in a diagnostic flow-chart. The pathogenesis, clinical signs, prognostic importance, and technical considerations for computer tomography and magnetic resonance imaging are briefly discussed. The anatomical pathways of the cranial nerves (CNs) and the main check-points are synthesized. Most commonly affected nerves are the trigeminal and facial, although any of the CNs may be involved. The described imaging features represent important clues for an optimal differential diagnosis. PNS worsens the prognosis and significantly changes the treatment, thus radiologists should be aware of this entity and be able to find it on imaging in the appropriate clinical context.

Breast cancer screening programs using mammography proved their value in detecting breast cancer at early stages and, consequently, reducing the mortality from this disease. Due to the technological progress, the screening programs have shifted from screen-film mammography to digital mammography and nowadays digital breast tomosynthesis became the focus of breast imaging research. Using tomosynthesis in screening increases cancer detection rates and decreases recall and false-positive rates, thus improving the effectiveness of breast cancer screening programs, with positive consequences on health care costs and on patient psychology. More long-term follow-up data must be collected for assessing absolute sensitivity and specificity of digital breast tomosynthesis, together with efforts for addressing the limitations of the method.

Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.