Post-Reconstruction Breast

Author(s):  
Melissa M. Joines

Breast reconstruction may be performed after mastectomy to improve breast symmetry. Each reconstruction technique leads to a characteristic appearance on post-operative imaging; thus, familiarity with the surgical techniques as well as the imaging features of the reconstructed breast across multiple modalities is important for radiologists. In addition, an understanding of the common benign complications as well as features of tumor recurrence is important. This chapter, appearing in the section on interventions and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for the reconstructed breast. Topics discussed include tissue expander/implant and autologous tissue flap reconstruction, reconstruction complications, tumor recurrence, and management recommendations.

2015 ◽  
Vol 8 (3) ◽  
pp. 161
Author(s):  
Samuel Gideon

This research was conducted as a learning alternatives for study of CT (computed tomograpghy) imaging using image reconstruction technique which are inversion matrix, back projection and filtered back projection. CT imaging can produce images of objects that do not overlap. Objects more easily distinguishable although given the relatively low contrast. The image is generated on CT imaging is the result of reconstruction of the original object. Matlab allows us to create and write imaging algorithms easily, easy to undersand and gives applied and exciting other imaging features. In this study, an example cross-sectional image recon-struction performed on the body of prostate tumors using. With these methods, medical prac-titioner (such as oncology clinician, radiographer and medical physicist) allows to simulate the reconstruction of CT images which almost resembles the actual CT visualization techniques.Keywords : computed tomography (CT), image reconstruction, Matlab


2021 ◽  
Vol 82 (01) ◽  
pp. 081-090
Author(s):  
Jacquelyn Laplant ◽  
Kimberly Cockerham

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.


Author(s):  
Ahmed S. Abdelrahman ◽  
Manar Maamoun Mohamed Ashour ◽  
Tougan Taha Abdelaziz

Abstract Background The neck imaging reporting and data system (NI-RADS) is a structured reporting algorithm linked with further patient management recommendations. This study was conducted to assess the overall and time point predictive value of the NI-RADS in laryngeal and oral cavity squamous cell carcinoma (SCC) using contrast-enhanced magnetic resonance imaging (CEMRI) and contrast-enhanced computed tomography (CECT). Results The rate of tumor recurrence was statistically different among the NI-RADS 1-3 categories with recurrence trend for higher NI-RADS scores. The overall negative predictive value (NPV) of the NI-RADS 1 and 2 were 94.3%, 74.3% respectively, and the positive predictive value (PPV) of the NI-RADS 3 was 80.8%. The overall recurrence rate of NI-RADS 3 was higher in oral cavity SCC (87.5%) compared to the laryngeal SCC (70%). The PPV of overall NI-RADS 3 in the follow-up scans (77.8%) was higher than in the first scan (70.6%). The odd ratio of tumor recurrence in NI-RADS 3 primary lesion was 19.6. Conclusion The predictive value of NI-RADS was significantly different among its categories. Increasing NI-RADS score is associated with increased recurrence among the treated laryngeal and oral cavity SCC. The morphological and enhancement lexicon features equally assign the NI-RADS 3 score.


2021 ◽  
Author(s):  
Giulio Cecchini ◽  
Huy Q Truong ◽  
Francesco Di Biase ◽  
Antonio Musio ◽  
Juan C Fernandez Miranda

Abstract BACKGROUND Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. OBJECTIVE To describe the anatomic and technical nuances of the transposition of the temporoparietal fascial flap for lower clivus reconstruction. METHODS A specific temporoparietal fascial flap (TPFF) design and tunneling technique has been studied using 4 head specimens, microscopic and endoscopic surgical techniques, and neuronavigation. RESULTS The L-shaped flap offers several advantages. It can be tunneled directly toward the lower clivus passing through the infratemporal fossa. CONCLUSION The infratemporal retro-eustachian transposition of an L-shaped TPFF provides a vascularized tissue virtually without dimension limits. This is the only technique that allows the flap to be tunneled directly in the lower clivus with the most vascular portion being at the bottom of the defect. Clinical validation is still required since more issues may become relevant in a real-surgery setting. Though, due to its possible complications, this methodology needs further testing and should not be attempted in less experienced hands.


Author(s):  
Mark D. Kettler

A fibroadenoma is a benign fibroepithelial breast tumor arising from the terminal duct-lobular unit (TDLU), composed of epithelial and stromal elements. The overwhelming majority of fibroadenomas present as palpable or imaging-detected circumscribed masses showing sharp demarcation between the lesion and the adjacent breast tissue. Fibroadenomas are the most common benign breast tumor occurring in women, with a peak incidence in the third and fourth decades, but they can occur from childhood through the eight decade of life. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key clinical and imaging features, differential diagnosis, and management recommendations for fibroadenomas.


Author(s):  
Mark D. Kettler

Benign cysts can occur in women of all ages, but they have a predilection for women in their 40s and 50s, and are far less common in younger and older women. Most cysts arise at the level of the terminal duct-lobular unit (TDLU); less commonly, cysts are caused by ectasia of central ducts. This chapter, appearing in the section on circumscribed mass, reviews the key clinical and imaging features, differential diagnosis, and management recommendations for primary cystic masses, including simple cysts, complicated cysts, and clustered microcysts. Careful assessment of sonographic features usually allows a definitive diagnosis of these benign entities that do not typically require tissue sampling. Some complex masses containing fluid and/or cystic-appearing components may require tissue sampling for diagnosis.


Author(s):  
Anna I. Holbrook

Vascular calcifications lie within the artery wall, and appear to be linear, usually in association with blood vessels. The parallel or “tram-track” appearance of the calcifications in opposite walls of the artery is pathognomonic. They are more prevalent with age. They are also associated with diabetes, renal disease, hyperparathyroidism, parity, and history of lactation, and possibly, cardiovascular disease. Vascular calcifications in the breast are within the arterial wall media, where they are known as Mönckeberg medial calcific sclerosis. This chapter reviews the key imaging features, imaging protocols, differential diagnoses, and management recommendations for vascular calcifications. Topics discussed include demographics and comorbidities, linear calcifications, and diagnostic workup.


Author(s):  
Stephanie A. Lee-Felker ◽  
Colin J. Wells

Pleomorphic calcifications are categorized among calcifications with suspicious morphology: amorphous, coarse heterogeneous, fine linear or fine-linear branching, and fine pleomorphic calcifications. Unlike amorphous calcifications, pleomorphic calcifications are more conspicuous, with discernible shapes that appear predominantly irregular, and are variable in size and configuration. A segmental distribution, seen as a triangular shape with its apex centered at the nipple, is especially suspicious for ductal carcinoma in situ (DCIS) or multifocal breast cancer, as its pattern of calcium deposition suggests involvement of a duct system within the breast. This chapter, appearing in the section on calcifications, reviews the key clinical and imaging features, imaging protocols, differential diagnoses, and management recommendations for pleomorphic calcifications. Topics discussed include characteristic morphology and distribution of pleomorphic calcifications, BI-RADS assessments, core needle biopsy, and radiological–pathological correlation.


2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095333
Author(s):  
Caitlin M. Rugg ◽  
Austin A. Pitcher ◽  
Christina Allen ◽  
Nirav K. Pandya

Background: High failure rates have been documented after anterior cruciate ligament reconstruction (ACLR) in pediatric patients, and revision surgery is indicated due to high activity levels of children and adolescents. Purpose: To define trends in revision ACLR in patients who underwent initial ACLR at younger than 18 years. Study Design: Case series; Level of evidence, 4. Methods: An electronic medical record was used to retrospectively identify revision ACLR procedures performed by 2 surgeons between the years 2010 and 2016 in patients younger than 18 years at initial reconstruction. Descriptive information, intraoperative findings, surgical techniques, and rehabilitation data were recorded from initial and revision surgeries. Descriptive statistics were used. Results: A total of 32 patients (17 girls, 15 boys) met the inclusion criteria, with a mean age of 15.8 years at initial reconstruction. For initial reconstructions, 15 patients underwent transphyseal procedures, 3 patients underwent adult-type procedures using an anatomic reconstruction technique that did not take into account the physis, and 2 patients underwent partial intraepiphyseal procedures. Graft types included hamstring autograft (n = 17), allograft (n = 5), hybrid (n = 4), and bone–patellar tendon–bone autograft (BTB; n = 3). Average primary reconstruction graft diameter was 8.0 mm (girls, 7.72 mm; boys, 8.36 mm; P = .045). After initial reconstruction, 10 patients had postoperative protocol noncompliance, and 8 patients reported delayed recovery. Mean time to retear was 565 days (range, 25-1539 days). At revision, BTB autograft was used in 50% (n = 16), followed by hamstring autograph (31.3%; n = 10) and allograft (12.5%; n = 4); mean graft diameter was 9.05 mm. Chondral surgery was more common during revision (25% for revision vs 0% for index; P = .031). There were 4 patients who required staged reconstruction with bone grafting. At mean final follow-up of 29.5 months (SD, 22.2 months), there were 3 graft failures (9.4%) and 5 contralateral ACL ruptures (15.6%). Conclusion: Most patients with ACL graft failure were adequately treated with a single revision. Conversion from a soft tissue graft to a BTB autograft was the most common procedure. Infrequently, patients required staged reconstructions. Providers should have a high index of suspicion for associated intra-articular injuries resulting from graft failure in adolescent patients.


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