Comprehensive Textbook of Clinical Radiology Volume V: Obstetrics imaging and The Breast
- 1st Edition - May 15, 2023
- Imprint: Elsevier India
- Editors: C Amarnath, B.S.Rama Murthy, Bagyam Raghvan, Hemant Patel, Jyoti Arora, Niketa Chotai, Supriya Kulkarni, BIJAL JHANKHARIA
- Language: English
- Hardback ISBN:9 7 8 - 8 1 - 3 1 2 - 6 3 6 5 - 5
- eBook ISBN:9 7 8 - 8 1 - 3 1 2 - 6 3 6 6 - 2
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• Divides the contents of each volume into sections – to mirror the way you practice.
• Includes topics like Paediatrics Oncology and Interventional Radiology in each section for a holistic approach.
• Provides content written by more than 500+ prominent authors across the globe and further edited by more than 50+ editors of global repute.
• Organizes the material in structured, consistent chapter layouts for efficient and effective review.
• Contains heavily illustrated radiographical images along with additional CT, HRCT and MR correlative images.
• Contains a dedicated volume on obstetrics for the first time in history of radiology textbooks in India.
• Covers the gamut of obstetric imaging in the interventions of obstetrics and their advancement.
• Interventions and biopsies in breast are explained in a lucid manner, which can be useful to a beginner or even subspeciality practising radiologist.
• Comprises additional online chapters in each volume with online references and other ancillary materials which would make learning and understanding much easier.
- Cover image
- Title page
- Table of Contents
- Copyright
- Foreword
- Foreword
- Foreword
- Preface
- Contributors
- List of Tables
- List of Illustrations
- Section 12. Obstetrics Imaging
- Part 1. General Section
- 12.1. The obstetric ultrasound examination
- Screening versus indicated US examination
- The equipment
- Obtaining history
- Paperwork
- Structured ultrasound examination
- Construction of report
- Technical difficulties
- Documentation of images
- Interaction with the couple
- Legal aspects
- 12.2. Obstetric ultrasound equipment
- Components of an US system
- Segments or range of US systems
- Types of US systems
- Decision criteria and process for purchasing an US equipment
- Characteristics of sound waves and principle of ultrasonic imaging
- Types of sound waves
- Interaction of US with tissues
- Greyscale imaging
- M-mode
- 3D/4D/3D live
- Types of transducers
- Resolutions in an image
- System operation
- Advanced imaging techniques
- Measurements and calculations
- Worksheet and report
- Documentation
- Doppler imaging
- 3D/4D imaging
- Safety of US
- Image management system
- 12.3. Ultrasound assessment of the 5–11 weeks of pregnancy
- Introduction
- Carnegie staging and sonoembryology
- Landmark events
- Gestational age
- Early pregnancy failure
- Bleeding in early pregnancy
- Assessment of the uterus – postevacuation
- Assessment of embryonic anatomy and anomalies
- Hydatidiform mole
- Multiple gestation
- Other pelvic lesions
- Ectopic pregnancy
- Part 2. Ultrasound Assessment of the 11 to 14 Weeks Pregnancy
- 12.4. 11 to 14 weeks of pregnancy: Biometry, markers of aneuploidy and assessment of gestational age
- Biometry
- Assessment of gestational age
- Screening for aneuploidy
- Screening for open spina bifida
- Fetal anatomy
- What not to report in first trimester in 11 to 13 weeks + 6 days examination
- 12.5. 11–14 weeks of pregnancy: Screening for aneuploidy and preeclampsia/IUGR
- Screening for aneuploidy
- Timing for aneuploidy screening
- Maternal characteristics
- Ultrasound markers of aneuploidy
- Biochemical markers of aneuploidy
- Transport of maternal blood to the laboratory
- A priori risk and patient-specific risk
- Noninvasive prenatal testing
- Counselling
- Key points
- Screening for preeclampsia and fetal growth restriction
- Definitions of preeclampsia and gestational hypertension
- Physiology of placentation
- Defective placental implantation
- Adverse pregnancy outcomes
- Screening in first trimester – protocol
- Role of biochemical markers
- Role of maternal mean arterial blood pressure
- Role of uterine artery doppler
- Normal uterine artery doppler waveform
- Uterine artery waveform early diastolic notching
- Technique of first-trimester uterine artery doppler
- Value of sequential first- and second-trimester evaluation
- Multiple gestation
- Aspirin as prophylaxis
- Key points
- 12.6. 11–14 weeks of pregnancy: Anomalies of CNS, face, neck and chest
- Introduction
- Transducer selection
- Fetal central nervous system
- Standard planes for the assessment of fetal head
- Standard planes for the assessment of fetal spine
- Anomalies of the central nervous system
- Fetal face
- Fetal chest
- 12.7. 11–14 weeks of pregnancy: Anomalies of CVS, GUT, GIT and skeletal system
- Cardiovascular system (CVS)
- Gastrointestinal tract (GIT)
- Arterial anomalies
- Venous abnormalities
- Genitourinary tract (GUT)
- Skeletal system
- 12.8. 11–14 weeks of pregnancy: Multiple gestation
- Introduction
- Recognition of multiple gestation and viability
- Gestational age assessment
- Chorionicity and amnionicity
- Screening for aneuploidy in twin gestation
- Discordant nuchal translucency or crown−rump length as predictors of poor outcome
- Placental insertion site of umbilical cord
- Structural anomalies
- Complications unique to monochorionic twin pregnancy
- Monochorionic monoamniotic twin pregnancy and cord entanglement
- Counselling
- Part 3. Ultrasound Assessment of the 18 to 22 Weeks Pregnancy
- 12.9. 18–22 weeks of pregnancy: Biometry, anomaly scan and gestational age
- General considerations
- Assessment of gestational age
- Assessment of fetal morphology
- Assessment of soft markers for aneuploidy
- Assessment of the fetal environment
- Role of 3D/4D ultrasound
- Tips for a good examination
- 12.10. Fetal central nervous system: Embryology, basic examination and neurosonogram
- Sonoanatomy
- Fetal brain
- Spine
- 12.11. Supratentorial midline anomalies, malformations of cortical development and ventriculomegaly
- Supratentorial midline anomalies
- Malformations of cortical development
- Ventriculomegaly
- 12.12. Fetal central nervous system – anomalies of posterior cranial fossa, cysts and tumours and destructive disorders
- Applied embryology of posterior fossa
- Morphometry of midbrain and hindbrain
- Posterior cranial fossa lesions
- Mega cisterna magna
- Blake’s pouch cyst
- Vermian hypoplasia
- Dandy–walker malformation
- Joubert syndrome and related disorders
- Cerebellar hypoplasia
- Rhombencephalosynapsis
- Intracranial cysts
- Normal midline cystic spaces
- Interhemispheric cyst
- Dorsal cyst
- Arachnoid cyst
- Vein of galen malformation
- Dermoid cyst
- Connatal cyst
- Periventricular pseudocyst
- Cystic leukomalacia
- Choroid plexus cysts
- Intracranial tumours
- Destructive disorders of fetal brain (haemorrhage, infection and ischaemia)
- Intracranial haemorrhage
- Infections of fetal brain
- Other destructive brain lesions
- 12.13. Fetal central nervous system: Anomalies of dorsal induction
- Aetiology
- Classification of neural tube defects
- Cranial defects
- Spinal defects
- Other lesions
- 12.14. Fetal face: Embryology, standard planes, anomalies and craniosynostosis
- Introduction
- Embryology
- Ultrasound appearances of the normal face
- Orbits
- Cleft lip and palate
- Anomalies of the external ear
- Abnormalities of the nose
- Abnormalities of mandible
- Abnormalities of tongue
- Dysmorphic face
- Tumours
- Craniosynostosis
- 12.15. Fetal neck: Dorsal and ventral masses
- Introduction
- Cystic hygroma
- Cervical teratoma
- Lymphangioma and haemangioma
- Goitre
- Key points
- 12.16. Fetal thorax: Applied embryology, standard planes of section and anomalies
- Developmental considerations
- Imaging techniques
- Congenital diaphragmatic hernia
- Congenital pulmonary airway malformation
- Bronchopulmonary sequestration
- Congenital high airway obstruction syndrome
- Bronchogenic cyst
- Lung agenesis – aplasia – hypoplasia
- Bronchial atresia
- Congenital lobar emphysema
- Neurenteric cyst
- Fetal hydrothorax
- 12.17. Fetal cardiovascular system: Applied embryology, standard planes of section, image optimization and incidence of congenital heart disease
- Incidence of congenital heart disease
- Embryology of normal heart and congenital heart disease
- Image optimization of congenital heart disease
- Standard planes of section
- 12.18. Fetal cardiovascular system: Septal defects and univentricular anomalies
- Atrial septal defect
- Key points
- Ventricular septal defect
- Key points
- Atrioventricular septal defect
- Key points
- Univentricular anomalies
- Key points
- 12.19. Fetal cardiovascular system: Anomalies of left side of the heart and great arterial arches
- Aortic stenosis
- Hypoplastic left heart syndrome
- Coarctation of aorta
- Anomalies of aortic arch
- 12.20. Fetal cardiovascular system: Anomalies of the right side of the heart
- Introduction
- Tricuspid regurgitation
- Ebstein anomaly
- Tricuspid dysplasia
- Tricuspid atresia
- Pulmonary stenosis
- Pulmonary atresia with intact ventricular septum
- Premature constriction/closure of ductus arteriosus
- 12.21. Fetal cardiovascular system: Conotruncal anomalies
- Conotruncal anomalies
- Tetralogy of fallot
- Pulmonary atresia with ventricular septal defect
- Absent pulmonary valve syndrome
- Common arterial trunk
- Double outlet right ventricle
- Interrupted aortic arch
- Thymus hypoplasia/aplasia
- 12.22. Fetal cardiovascular system: Transposition of great arteries, heterotaxy, anomalies of pulmonary, systemic and portal venous systems
- Transposition of the great arteries
- Heterotaxy
- Pulmonary venous system
- Systemic venous system
- Umbilical–portal–systemic venous shunts
- 12.23. Fetal cardiovascular system: Arrhythmias, functional evaluation, cardiomyopathy and tumours
- Fetal arrhythmias
- Conduction system of heart
- Modalities to assess rhythm
- Cardiomyopathy and cardiac functional assessment
- Cardiac tumours
- 12.24. Fetal gastrointestinal tract: Embryology, standard planes of sections, anomalies of GIT and hepatobiliary system
- Applied embryology of fetal gastrointestinal tract
- Normal gastrointestinal tract
- Miscellaneous causes of bowel obstruction
- Anomalies of hepatobiliary system
- Abdominal cysts
- 12.25. Fetal anterior abdominal wall: Embryology, standard planes of section and anomalies
- Embryology of anterior wall defects
- Cord insertion site in relation to the AWD
- Key points
- 12.26. Fetal urinary system: Embryology, standard planes of section and anomalies
- Introduction
- Applied embryology of fetal urinary system
- Renal abnormalities without urinary tract dilatation
- Urinary tract dilation
- Urinary tract obstruction
- Cystic renal diseases
- Bladder and cloacal exstrophy and renal tumours
- 12.27. Fetal adrenals and genitalia
- Adrenals
- Genitalia and disorders of sexual differentiation
- 12.28. Fetal skeletal system: Embryology, standard planes of section, limb anomalies
- Development of limbs: Applied embryology
- Sonographic embryology
- Standard planes of section and normal appearances
- Amniotic band sequence
- Arthrogryposis
- Congenital genu recurvatum
- Clinodactyly
- Ectrodactyly
- Polydactyly
- Syndactyly
- Club hand
- Club foot
- Transverse limb defects
- Proximal focal femoral deficiency
- Posteromedial tibial bowing
- Sirenomelia
- 12.29. Fetal skeletal system: Skeletal dysplasias
- Introduction
- Aetiopathogenesis
- Skeletal ossification
- Lethal skeletal dysplasias
- Nonlethal skeletal dysplasia
- Summary
- 12.30. The genetic sonogram: Markers of chromosomal abnormalities, risk assessment
- Introduction
- Structural anomalies
- Early-onset intrauterine growth restriction
- Markers of aneuploidy
- Genetic sonogram – risk assessment
- Triaging by risk assessment and counselling
- Role of genetic sonogram
- Conclusion
- 12.31. Fetal syndromes: Approach, ultrasound diagnosis and genetics
- 12.32. Fetal anaemia and fetal hydrops
- Fetal anaemia
- Fetal hydrops (hydrops fetalis)
- Part 4. Placenta, Umbilical Cord, Amniotic Fluid and Cervix
- 12.33. Placenta: Normal and abnormal
- Introduction
- Normal placenta and US appearences
- Variations of placental morphology
- Variations of placental thickness
- Abnormalities of placental cord insertion
- Abnormalities of placental location
- Placenta accreta spectrum
- Placental abruption and placental haematoma
- Gestational trophoblastic disease
- Nontrophoblastic placental tumours – chorioangioma
- Miscellaneous lesions of placenta
- Conclusion
- 12.34. Umbilical cord: Normal and abnormal
- Introduction
- Embryology
- Cord evaluation in the first and second trimesters
- Ultrasound appearance of normal umbilical cord
- Placental cord insertional abnormalities
- Fetal cord insertion abnormalities
- Presentation abnormalities
- Cord coiling abnormalities
- Nuchal cord
- Cord knots
- Cord cysts
- Cord vascular abnormalities
- Supernumerary umbilical cord vessels
- Persistent right umbilical vein
- Umbilical artery aneurysm
- Miscellaneous
- 12.35. Amniotic fluid in health and disease
- Functions of amniotic fluid
- Composition of amniotic fluid
- Production and dynamics of amniotic fluid
- Estimation of amniotic fluid volume
- Estimation of amniotic fluid volume in multiple gestations
- The pitfalls in amniotic fluid estimation
- Amniotic fluid volume abnormalities
- Amniotic fluid particulate matter
- Amniotic wrinkle
- 12.36. Cervical assessment in pregnancy
- Introduction
- Significance of predicting preterm birth
- Incompetence of cervix
- Measurement of cervical length: Role in predicting preterm birth
- Additional ultrasound findings associated with cervical assessment
- Pitfalls
- Recent advances
- Key points
- Part 5. Fetal Growth and Well-Being
- 12.37. Assessment of fetal growth: Normal and abnormal (FGR)
- Assignment of gestational age in the first trimester
- Assessment of fetal growth
- Definition of small for gestational age fetus
- Definition of CS fetus
- Definition of early onset FGR
- Definition of late onset FGR
- References
- 12.38. Technique of obstetric doppler and waveform interpretation
- Introduction
- General guidelines
- Umbilical artery
- Middle cerebral artery
- Cerebroplacental ratio
- Second-/third-trimester uterine artery doppler
- Ductus venosus
- Aortic isthmus
- 12.39. Fetal growth restriction: Surveillance and delivery decisions
- Introduction
- Aetiology of FGR
- Early versus late fetal growth restriction
- Tools for antepartum surveillance
- Recommendations for surveillance and management of fetal growth restriction
- The small for gestational age fetus
- Prognosis for FGR
- Summary
- 12.40. Fetal macrosomia: Definition, diagnosis, classification and monitoring
- Introduction and definition
- Aetiology and incidence
- Risk factors
- Types
- Pathophysiology
- Growth patterns
- Prediction in the first trimester
- Prediction in the second and third trimesters
- Monitoring
- Role of biomarkers
- Role of doppler
- Outcomes
- Conclusion
- Part 6. Multiple Pregnancy
- 12.41. Multiple gestation: Part I
- General considerations
- Dating of twin pregnancy
- Zygosity versus chorionicity and amnionicity
- Chorionicity and amnionicity
- Labelling in twins
- Vanishing twin
- Screening for risk of preterm birth
- Screening for chromosomal abnormalities
- Screening methods
- Structural fetal anomalies
- Invasive procedures
- Fetal reduction
- 12.42. Multiple gestation: Part II
- Angioarchitecture of placenta in monochorionic twins
- ISUOG guidelines for monitoring monochorionic twins
- Vascular complications of monochorionic twins
- Managing surviving twin in monochorionic twins
- Monochorionic monoamniotic twins
- Incidence of malformations and genetic defects in monochorionic twins
- Conclusion
- Part 7. Miscellaneous
- 12.43. Acute abdomen in pregnancy
- Upper abdominal pain
- Lower abdominal pain
- Pelvic pain
- Conclusion
- 12.44. Fetal MRI: General considerations, fetal and other obstetric applications
- Central nervous system
- Face and neck
- Fetal chest
- Cardiovascular system
- Abdominal wall and gastrointestinal (GI) system
- Genitourinary (GU) system
- Musculoskeletal system and miscellaneous
- Fetal growth retardation
- Applications in the study of placenta
- Miscellaneous applications
- 12.45. 3D and 4D obstetric ultrasound: User’s guide
- Volume acquisition
- Volume manipulation and display
- 12.46. Invasive procedures for prenatal diagnosis and therapeutic interventions
- Introduction
- Chorionic villus sampling
- Amniocentesis
- Fetal blood sampling (cordocentesis)
- Shunt procedures
- Needle aspiration
- 12.47. Genetics: Basics and application in fetal medicine
- Introduction
- The fundamental concepts in genetics
- Chromosomal disorders
- Chromosomal abnormalities of number
- Abnormalities of chromosomal structure
- Chromosomal testing in fetal medicine
- Molecular genetic testing
- Applications in fetal medicine through case scenarios and key messages
- Conclusions
- 12.48. Fetal autopsy
- Introduction
- Role of fetal or a perinatal autopsy
- Indications for fetal autopsy
- Steps of fetal autopsy
- Components of a fetal autopsy
- Fetal autopsy: The procedure
- The autopsy procedure
- Post-test counselling
- Case scenarios
- Conclusions
- Acknowledgements
- 12.49. Drug and radiation teratogenicity
- Drug teratogenicity
- Introduction
- Principles of teratology
- Gestational age and teratogenic susceptibility of the embryo/fetus
- Dose–response relationship of teratogens
- Causes of birth defects
- Teratogenic risk counselling
- Role of ultrasound in teratogenesis
- Drug risk classification in pregnancy
- Specific drugs and their teratogenic effects
- Drugs for cardiovascular disease
- Psychiatric drugs
- Antidepressants
- Antipsychotics
- Anxiolytic drugs
- Antirheumatic drugs
- Antimicrobials
- Antifungal
- Antiviral drugs
- Antithyroid drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
- Hormonal agents
- Androgens
- Radiation teratogenicity
- Introduction
- Radiation quantities and units
- System of radiological protection
- Molecular and cellular characteristics of ovary
- Radiation-induced cancer in human
- Radiation effects in utero
- Effects of radiological investigations
- Nuclear medicine examinations
- Estimation of radiation dose
- Management of pregnant and potentially pregnant patients
- Magnetic resonance imaging and bioeffects
- Summary
- Acknowledgement
- Section 13. The Breast
- 13.1. Radiological and imaging techniques with protocol
- 13.1.1. X-RAY MAMMOGRAPHY
- Introduction
- 13.1.1.1. POSITIONING AND ARTEFACTS
- Quality check
- Mammography views
- Routine mammogram
- Additional views
- Special views to overcome overlapping tissues
- Male mammography (Fig. 13.1.1.1.19)
- Implant-displaced/Eklund views
- Film labelling
- Reading the mammogram
- Artefacts in mammography
- Triangulation
- Localization of lesion in mammography
- 13.1.1.2. MASS
- Mass
- Role of mammography in detection of mass
- Breast parenchymal pattern/density as a risk factor and its significance in detection of mass on mammography
- Location of mass in mammography
- BI-RADS lexicon for a mass
- Benign masses
- Masses with risk of malignancy
- Inflammatory pseudomasses
- Malignant masses
- Fat-containing lesions
- 13.1.1.3. BREAST CALCIFICATIONS
- Introduction
- Breast calcifications
- Modalities used in breast imaging for diagnosis
- Role for X-ray diffraction in understanding breast pathology based on microcalcification chemistry and formation
- Imaging techniques in finding calcifications
- Tomosynthesis in identifying calcifications
- CAD in calcifications
- USG
- Doppler
- Diagnostic approach
- Postsurgical breast
- Artefacts
- Suspicious calcifications
- Highly suspicious calcifications
- American college of radiology breast imaging-reporting and data system (Bi-RADS) (Fig. 13.1.1.3.31)
- 13.1.1.4. ASYMMETRY AND ARCHITECTURAL DISTORTION
- Introduction
- Asymmetries
- Types of asymmetries
- Architectural distortion
- 13.1.2. BREAST ULTRASOUND
- 13.1.2.1. BREAST ULTRASOUND
- Introduction
- Technique
- Artefacts
- USG breast lexicon and descriptors
- Mammography and USG correlation
- 13.1.2.2. BREAST ELASTOGRAPHY
- Introduction
- Types of elastography and techniques
- Interpretation
- Conclusion
- 13.1.2.3. CYSTIC LESIONS: A MULTIMODALITY APPROACH
- Simple cysts
- Imaging features
- Clustered cysts
- Complicated cysts
- Complex solid-cystic lesions
- Imaging features
- Intervention
- Teaching point
- 13.1.3. BREAST MRI
- Introduction
- MRI protocols and technical guidelines
- Postprocessing techniques
- Artefacts
- Clinical indications of breast MRI
- Inappropriate uses of breast MRI
- Reporting breast MRI
- Interpretation/BI-RADS lexicon
- Kinetic information
- Conclusion
- 13.1.4. ACR BI-RADS
- ACR BI-RADS assessment categories
- Management of probably benign lesions
- Assessment–management concordance
- Frequently asked questions
- 13.1.5. DIGITAL BREAST TOMOSYNTHESIS: PHYSICS
- Basic concept
- Tube motion
- Sweep angle
- Number of projections
- Image reconstruction
- Radiation dose
- DBT artefacts
- DIGITAL BREAST TOMOSYNTHESIS – CLINICAL APPLICATIONS
- Screening outcomes
- Advantages of digital breast tomosynthesis in diagnostic mammograms
- 13.1.6. SCREENING (AVERAGE RISK AND HIGH RISK – ALL MODALITIES)
- Introduction
- Clinical breast examination and breast self-examination
- Screening mammography
- Benefits and harms of screening mammography
- Risk assessment for breast cancer
- Guidelines for screening of breast cancer
- Suggested screening recommendations for high-risk women
- Breast density and its implication on screening
- Medical audit of mammography and its performance indicators
- Indian perspective
- Key/crux points for breast cancer screening
- 13.1.7. ERRORS IN BREAST IMAGING: SYSTEMATIC APPROACH, MEDICOLEGAL IMPLICATIONS AND MANAGEMENT STRATEGIES
- Introduction
- Objectives
- Error or discrepancy
- Types of error
- Process of identifying errors
- Clinical governance
- Medicolegal implications in breast radiology
- Strategies to reduce error
- Conclusion
- 13.1.8. SCINTIMAMMOGRAPHY, PEM AND PET/CT
- Scintimammography
- Positron emission mammography
- PET/CT in breast cancer
- Clinical utility
- Pitfalls and limitations of 18F-FDG PET/CT
- Recent technological advances
- 13.1.9. ROLE OF PET-MRI IN CARCINOMA BREAST
- Introduction
- Instrumentation
- Technical challenges in combining PET and MRI
- Attenuation correction in PET-MRI systems
- Attenuation artefacts in PET-MRI
- PET radiotracers
- PET-MRI protocol
- PET-MRI: Indications and clinical applications
- Indications of PET-MRI in breast cancer
- Artefacts and challenges faced during PET-MRI
- Case studies
- 13.2. Radiological anatomy of the breast
- 13.2.1. SEGMENTAL AND ZONAL ANATOMY OF THE BREAST
- Introduction
- Segmental anatomy
- Clinical significance
- Imaging features
- Changes with the menstrual cycle
- Pregnancy and lactational changes
- Changes with menopause
- Zonal anatomy as applied to radiology
- 13.2.2. NIPPLE−AREOLAR COMPLEX AND SKIN
- Introduction
- Anatomy
- Imaging appearances
- Conclusion
- 13.2.3. AXILLARY LYMPH NODAL ANATOMY AS APPLIED TO RADIOLOGY
- Introduction
- Anatomy
- Imaging appearances
- Clinical significance
- Conclusion
- 13.2.4. NEUROVASCULAR ANATOMY
- Introduction
- Anatomy
- Normal imaging appearances of the vessels
- 13.2.5. ANATOMY OF CHEST WALL
- Introduction
- Anatomy
- Imaging features
- Clinical significance
- Conclusion
- 13.3. Normogram
- 13.3.1. NORMOGRAM
- 13.4. Radiologic approach to breast lesions
- 13.4.1. TRIPLE ASSESSMENT: A PRACTICAL APPROACH: UNDERSTANDING THE BASICS FROM A SURGICAL STANDPOINT
- Introduction
- Triple assessment
- Practical applications of triple assessment
- Conclusion
- 13.4.2. IMAGING APPROACH TO THE SYMPTOMATIC BREAST
- Introduction
- Breast mass
- Breast pain
- Nipple discharge
- Axillary nodes as palpable lumps
- Breast oedema
- Imaging
- Conclusion
- Imaging approach to palpable breast mass
- Imaging approach to breast pain
- Imaging approach to nipple discharge
- Approach to ductal pathologies
- Imaging approach to breast oedema
- Imaging approach to axillary lymphadenopathy
- 13.4.3. APPROACH TO MASSES: SOLID MASSES/FAT CONTAINING
- Case-based approach
- 13.4.4. CYSTIC LESIONS: FROM SIMPLE TO COMPLICATED AND COMPLEX
- Case-based approach
- Conclusion
- 13.4.5. APPROACH TO MAMMOGRAPHIC CALCIFICATIONS
- Understanding calcifications and the descriptors
- An algorithm for assigning the appropriate BI-RADS
- Case-based approach to calcifications – benign and malignant
- 13.4.6. APPROACH TO ASYMMETRIES AND ARCHITECTURAL DISTORTION
- Mammogram
- Breast ultrasound
- Stereotactic-guided biopsy
- Magnetic resonance imaging
- Postbiopsy management
- Approach to asymmetries
- Case-based illustrations
- A challenging scenario in primary AD detected only on DBT
- Conclusion
- 13.4.7. IMAGING APPROACH TO CHARACTERIZE A LESION ON BREAST MRI
- Tips to maximize the chances of obtaining a diagnostically useful breast mri study
- Case studies
- 13.4.8. MALIGNANCY MIMICS
- Postbiopsy management of BI-RADS 4 masses
- Case-based approach and commonly encountered mimic examples
- 13.5. Signs in breast imaging
- 13.6. Embryology, histology, developmental anomalies and paediatric breast conditions
- 13.6.1. EMBRYOLOGY AND DEVELOPMENT OF BREAST
- Introduction
- Prenatal breast development
- First trimester
- Second trimester
- Third trimester
- Infant breast
- Pubertal development
- Adult mammary gland development
- Involution
- Mammary stem cells and cancer stem cell hypothesis
- Conclusion
- Diagnostic pearls
- 13.6.2. THE PATHOLOGIC BASIS TO BREAST DISEASE
- Normal histology and physiologic changes in breast
- Diagnostic approach to breast lesions: An overview
- Role of immunohistochemistry in breast pathology
- Pathologic evaluation of breast specimens with radiological-pathological correlation
- Interpretation of a pathology report in breast cancer
- Invasive and in situ carcinoma – tumor size and focality
- Lymphovascular invasion
- Basic molecular pathology in breast cancer
- 13.6.3. DEVELOPMENTAL ANOMALIES OF THE BREAST
- Introduction
- Congenital anomalies of the nipple
- Congenital anomalies of the breast
- Abnormalities of the shape of breasts
- Congenital chest wall deformity
- Diagnostic pearls
- 13.6.4. PAEDIATRIC BENIGN AND MALIGNANT BREAST CONDITIONS
- Introduction
- Classification
- Benign breast developmental disorders
- Benign breast masses
- Malignant breast tumors
- Conclusions
- 13.7. Benign breast lesions
- 13.7.1. INFECTIONS AND INFLAMMATORY CONDITIONS OF THE BREAST
- Introduction
- 13.7.2. BENIGN BREAST DISEASE
- Introduction
- 13.7.3. INTERMEDIATE- AND HIGH-RISK LESIONS
- Introduction
- Phyllodes tumour
- Granular cell tumour
- Radial scar (elastosis, indurative mastopathy, radial sclerosing lesion)
- Fibromatosis
- Papillomas
- Atypical ductal hyperplasia and lobular neoplasia, including atypical lobular hyperplasia and lobular carcinoma in situ
- Atypical ductal hyperplasia
- Lobular neoplasia (ALH and LCIs)
- Conclusion
- 13.7.4. VASCULAR LESIONS IN THE BREAST
- Introduction
- Atherosclerosis
- Aneurysms
- Congestive heart failure
- Mondor disease
- Cavernous haemangiomas
- Breast sarcomas
- Conclusion
- 13.8. Premalignant and malignant lesion
- 13.8.1. DUCTAL CARCINOMA IN SITU (DCIS)
- Introduction
- Anatomy
- Pathology
- Imaging
- DCIS presenting as nipple discharge
- 13.8.2. INVASIVE DUCTAL CARCINOMA
- Introduction
- Pathology
- Clinical presentation
- Imaging
- Management of invasive ductal carcinoma
- Post-therapy imaging
- Machine learning in IDC
- Conclusion
- Key points
- 13.8.3. INVASIVE LOBULAR CARCINOMA
- Introduction
- Pathology
- Lobular neoplasia
- Invasive lobular carcinoma
- Pleomorphic ILC and higher grade variants of ILC
- Management
- Conclusion
- 13.8.4. MIXED INVASIVE DUCTAL AND LOBULAR CARCINOMA
- Pathology
- Clinical presentation
- Imaging
- Mammography
- Ultrasonography
- Magnetic resonance imaging
- Response assessment
- Management
- Follow-up assessment
- Key points
- 13.8.5. MEDULLARY CARCINOMA
- Historical perspective
- Anatomy/embryology
- Pathology, classification and general features
- Clinical presentation
- Imaging
- Imaging pearls and pitfalls
- Radiological differential diagnosis
- Prognosis and treatment
- Follow-up and surveillance
- 13.8.6. MUCINOUS CARCINOMA
- Epidemiology
- Anatomy/embryology
- Clinical presentations
- Pathology, classification and general features
- Macroscopic and microscopic features
- Immunohistochemistry
- Imaging
- Imaging pearls and pitfalls
- Radiological differential diagnosis
- Radiological-pathological correlation
- Prognosis and treatment
- Follow-up and surveillance
- 13.8.7. TUBULAR CARCINOMA
- Clinical presentations
- Pathology
- Imaging findings
- Differential diagnosis
- Radiopathological correlation in tubular carcinoma
- Treatment considerations in tubular carcinoma
- Post-treatment imaging follow-up
- Summary
- 13.8.8. PAPILLARY CARCINOMA
- Papillary carcinoma of the breast
- In situ papillary carcinomas
- Acknowledgements
- 13.8.9. INVASIVE MICROPAPILLARY CARCINOMA
- Epidemiology
- Clinical presentation
- Pathology
- Imaging features
- Radio-pathological correlation
- Treatment and surveillance
- Prognosis
- Summary
- 13.8.10. METAPLASTIC BREAST CARCINOMA
- Epidemiology and historical perspective
- Pathology
- Clinical presentation
- Imaging features
- Radiology-pathology correlation
- Treatment
- Prognosis
- Conclusion
- 13.8.11. INFLAMMATORY BREAST CANCER
- Introduction
- Clinical presentation
- Clinical criteria for diagnosis
- Pathological criteria for diagnosis
- Molecular criteria in inflammatory breast cancer
- Role of imaging in diagnosis of inflammatory breast cancer
- Differential diagnosis
- Staging of inflammatory breast cancer
- Role of imaging in assessing treatment response
- Treatment of inflammatory breast cancer
- Prognosis
- Imaging for recurrence
- Secondary inflammatory breast cancer
- Cancer stem cells and inflammatory breast cancer
- Summary
- 13.8.12. ADENOID CYSTIC CARCINOMA
- Epidemiology
- Historical perspective
- Clinical presentation
- Pathology
- Lymph node status
- Imaging features
- Differential diagnosis
- Prognosis and treatment
- Conclusion
- 13.8.13. TUBULOLOBULAR CARCINOMA
- Pathologic features
- Clinical profile
- Imaging
- Radiological differential diagnosis
- Management
- Post-therapy assessment
- Prognosis
- Conclusion
- 13.8.14. SARCOMA
- Introduction
- Clinical presentation
- Classification
- Staging
- Imaging findings
- Differential diagnosis
- Treatment and prognosis of breast sarcomas: General considerations
- Individual subtypes
- Rarer subtypes
- Conclusion
- 13.8.15. METASTASIS
- Introduction
- Mode of spread
- Clinical presentation
- Imaging
- Histopathology and IHC: Cancer of unknown primary
- Breast metastases from lymphoma
- Breast plasmacytoma
- Breast metastases from melanoma
- Breast metastases from the contralateral breast cancer
- Breast metastases from genitourinary carcinoma
- Other genitourinary carcinomas
- Breast metastases from the gastrointestinal tract
- Colorectal carcinoma
- Breast metastases from pancreatic carcinoma
- Breast metastases from lung cancer
- Breast metastases from the head and neck
- Breast metastases from sarcomas
- Summary
- 13.8.16. LYMPHOMA
- Epidemiology
- Clinical presentations
- Classification and pathology
- Imaging
- Sampling method
- Sample preservation
- Management
- Prognosis
- Breast implant–associated anaplastic large-cell lymphoma
- 13.9. Breast cancer staging and management
- 13.9.1. STAGING
- Introduction
- Historical perspective
- Role of imaging
- Eighth edition of the AJCC cancer staging manual
- Anatomic TNM staging:
- Stage migration
- Gene expression profiling and multigene panels
- Conclusion
- 13.9.2. BILATERAL BREAST CANCER
- Definition
- Epidemiology
- Risk factors
- Clinical presentation
- Histopathology and immunohistochemistry
- Breast imaging
- Bilateral breast cancer treatment
- Bilateral breast cancer prognosis
- 13.9.3. SURGICAL MANAGEMENT OF BREAST CANCER
- Introduction
- Role of surgery in breast cancer
- Role of imaging in planning surgical approach
- Surgery for the breast primary
- Contraindications for breast conservation surgery
- Principles of primary tumour excision
- Oncoplastic breast surgery
- Principles of axillary surgery
- Conclusion
- 13.9.4. MOLECULAR SUBTYPES OF BREAST CANCER
- Basic anatomy and histology of breast tissue
- Hormone receptors, HER2 protein and proliferation index
- Molecular subtypes of breast cancer
- Pathogenesis and cell of origin of the different subtypes
- Summary of the molecular subtypes of breast carcinoma
- Acknowledgements
- 13.9.5. GENOMIC TESTING IN BREAST CANCER
- Hereditary and familial breast cancer
- Gene profile tests
- Prosigna/PAM50
- Other assays
- Clinical trial support to treatment decisions
- Online tools
- Genomic testing for metastatic disease
- Acknowledgements
- 13.9.6. LOCALLY ADVANCED BREAST CANCER
- Definition
- LABC: Clinical presentation and staging
- Role of imaging in LABC
- Conclusion
- 13.9.7. OVERVIEW OF RADIATION TREATMENT IN BREAST CANCER
- Introduction
- How does radiation produce its effects?
- Historical perspective
- Evidence and rationale for radiotherapy
- Radiation therapy in nonmetastatic breast cancer
- Ductal carcinoma in situ
- Radiation toxicities
- Lung toxicity
- Cardiac toxicity
- Others
- Radiation fields and techniques
- Special techniques in left-sided breast cancer for cardiac sparing
- Timing of radiotherapy
- Dose and fractionation for breast irradiation
- Radiation boost to tumour bed
- Accelerated partial breast irradiation
- Techniques
- Clinically node-positive cases
- Clinically negative axilla
- Radiation following neoadjuvant chemotherapy
- Omission of RT in the elderly
- Radiation therapy in metastatic breast cancer
- Bone metastasis
- Brain metastasis
- Visceral metastasis (liver, lung)
- Key summary points
- Conclusion
- 13.9.8. CHEMOTHERAPY IN BREAST CANCER
- 13.9.8.1. ADJUVANT CHEMOTHERAPY IN BREAST CANCER
- Breast cancer heterogeneity
- Adjuvant treatment – why and for whom?
- Advantages of adjuvant treatment
- Disadvantages of adjuvant treatment
- Adjuvant treatment – what?
- Adjuvant treatment – how?
- Principle of use of combination chemotherapy/polychemotherapy
- Drug classes for adjuvant treatment of breast cancer
- Common combination regimens in breast cancer
- HER2-positive tumours
- Conclusions
- 13.9.8.2. NEOADJUVANT THERAPY IN BREAST CANCER
- Definition and history
- Genomic variance of breast cancer
- Neoadjuvant endocrine therapy
- Neoadjuvant chemotherapy
- Neoadjuvant treatment in triple-negative breast cancer
- Neoadjuvant treatment in HER2-enriched breast cancer
- Neoadjuvant chemoradiotherapy
- Pitfalls
- Conclusion
- 13.9.9. POSTOPERATIVE IMAGING OF THE BREAST
- Introduction
- Importance of clinical breast examination
- Postmastectomy imaging
- Imaging after breast reconstruction surgery
- Conclusion
- 13.9.10. SURVEILLANCE AFTER PRIMARY BREAST CANCER TREATMENT
- Introduction
- Mammography
- Digital breast tomosynthesis
- Breast MRI
- Whole-breast ultrasound
- Other modalities
- Special situation
- 13.9.11. RECURRENT BREAST CANCER
- Introduction
- Definition of recurrence
- Risk factors for recurrence
- Detection of locoregional recurrence
- Overview of management of recurrent breast cancer
- Locoregional recurrence
- Local recurrence
- Regional recurrence
- Recurrence in male breast cancers
- Conclusion
- 13.9.12. METASTATIC BREAST CANCER
- Introduction
- Staging
- Molecular subtypes of breast cancer
- Change in receptor expression of metastatic breast cancer
- Clinical presentation and imaging approach: Metastatic breast cancer
- Common sites of distant metastases of breast cancer
- Rare sites of intra-abdominal metastases of breast cancer
- Conclusion
- 13.9.13. TRIPLE-NEGATIVE BREAST CANCER
- Introduction
- Clinical presentation
- Pathology
- Other histologic subtypes
- Molecular classification
- Imaging characteristics
- Differential diagnosis
- Treatment
- Conclusion
- 13.10. Breast augmentation & post reduction imaging
- 13.10.1. IMAGING OF THE AUGMENTED BREAST
- Introduction
- Breast implants
- Other augmentation technique: Breast free filler injection – fat, silicone oil, PAAG
- Conclusion
- Diagnostic pearls
- 13.10.2. IMAGING OF THE RECONSTRUCTED BREAST
- Introduction
- Oncoplastic surgery
- Diagnostic pearls
- 13.11. Breast: Pregnancy and lactation
- Physiology of pregnancy and lactation
- Endocrinology of lactation
- Imaging evaluation
- Clinical presentation
- Screening in pregnancy
- Pathologies during pregnancy
- Summary
- 13.12. Male breast
- 13.12.1. MALE BREAST: ANATOMY AND BENIGN LESIONS
- Introduction
- Historical perspective
- Embryology and imaging anatomy
- Imaging of the male breast
- Common benign conditions of the male breast
- Benign masses of the male breast
- Conclusion
- 13.12.2. MALE BREAST: MALIGNANT CONDITIONS
- Introduction
- Conclusions
- 13.13. Axillary regions
- 13.13.1. Axilla
- Introduction
- Anatomy of axilla
- Contents of axilla
- Imaging modalities
- Axillary lesions
- Lesions of skin and subcutaneous tissues
- Lesions of accessory breast tissue
- Lymph node pathology
- Neural pathologies
- Axillary vascular lesions
- Miscellaneous lesions
- Extra-axillary lesions
- Conclusion
- 13.13.2. Nipple: Discharge, Retraction, Paget Disease
- Introduction
- Normal anatomy of the nipple–areolar complex region and the retroareolar ducts
- Imaging techniques for visualization of the NAC and the ductal system
- Nipple discharge
- Imaging appearances in common ductal pathologies
- Ductal carcinoma in situ (Fig. 13.13.2.14)
- Invasive ductal carcinoma (IDC)
- Paget disease of the breast
- Nipple retraction and inversion
- 13.13.3. SKIN AND CHEST WALL
- Superficial lesions in the breast
- Conclusion
- 13.14. Trauma and emergencies
- 13.14.1. TRAUMA, HAEMATOMA AND FAT NECROSIS
- Breast trauma
- Crush injury
- Grading of breast injury
- Shear injury
- Penetrating injury
- Iatrogenic trauma to the breast following image-guided procedures
- Pseudoaneurysm
- Fat necrosis
- 13.15. Breast interventions: The surgical perspective
- 13.15.1. TREATMENT APPROACHES TO BREAST LESIONS
- Introduction
- Image reporting standards
- Tissue biopsy
- Oncoplastic breast conservation surgery (OPCS)
- Role of neoadjuvant chemotherapy
- Role of marker clips
- Assessment of axillary nodes
- Management of impalpable lesions
- Benign breast conditions
- Summary
- 13.15.2. MODES OF INTERVENTION: FNAC, CORE BIOPSY AND MARKER CLIP
- Intervention in breast
- Radioactive isotope techniques
- 13.15.3. THERAPEUTIC PROCEDURES/VABB (RFA/LASER)
- Ablation techniques in breast cancer
- Ablation techniques in breast
- Percutaneous techniques available for breast tumour management
- Conclusion
- 13.15.4. MODALITIES FOR BREAST INTERVENTIONS: STEREOTACTIC, ULTRASOUND AND MRI
- Introduction
- Ultrasound guidance
- Stereotactic guidance
- MRI guidance
- US-guided breast biopsy
- US-guided FNAC
- US-guided aspiration
- US-guided wire localization
- US-guided clip placement
- US-guided vacuum-assisted breast biopsy
- Stereotactic breast biopsy
- MRI-guided vacuum-assisted breast biopsy
- Nonvisualization of the lesion
- Conclusions
- 13.15.5. RADIOLOGIC & PATHOLOGIC CO-RELATION (RAD-PATH CORELATION)
- Introduction
- Concordance and discordance
- Assessment for concordance
- Accurate targeting
- Adequate sampling
- Categories of imaging-pathologic concordance
- Postbiopsy counselling of the patient
- Navigation workflow
- Counselling
- Conclusion
- 13.16. Miscellaneous breast diseases
- 13.16.1. HORMONE REPLACEMENT THERAPY
- Introduction
- Action of oestrogen/progesterone
- Uses/types of hormone replacement therapy
- Action of HRT on breast
- Imaging
- Conclusion
- Key points
- 13.16.2. MULTIPLE BILATERAL ABNORMALITIES
- Introduction
- Imaging
- Types of bilateral breast masses
- Key points
- Management
- Conclusion
- 13.17. Rare breast disease
- 13.17.1. APPROACH AND CLASSIFICATION AND BENIGN AND MALIGNANT LESIONS
- Rare lesions of breasts
- Introduction
- Rare epithelial tumours of breast
- Rare mesenchymal tumours of breast
- Rare neuroendocrine tumours of breast
- Rare malignant lymphoma of breast
- Rare breast metastasis
- Rare inflammatory lesions of breast
- Conclusion
- 13.17.2. BREAST MANIFESTATIONS OF SYSTEMIC DISEASES
- Sarcoidosis
- Diabetic mastopathy
- Hashimoto thyroiditis–associated mastitis
- Lupus-associated mastitis
- Neurofibromatosis
- Amyloidosis of the breast
- Chronic renal disease–associated calciphylaxis
- Breast imaging in organ failure
- Systemic malignancies with breast involvement
- Secondary lymphoma
- Metastatic melanoma
- Summarized mammographic features of systemic diseases
- 13.18. Recent advances and future developments in breast imaging
- 13.18.1. CONTRAST-ENHANCED MAMMOGRAPHY
- Introduction
- Principle of dual-energy contrast-enhanced mammography
- Examination protocol
- Image acquisition
- Image interpretation
- Literature review
- Potential clinical applications for CEM
- Future directions
- Advantages
- Limitations
- Conclusion
- Diagnostic pearls
- 13.18.2. AUTOMATED BREAST ULTRASOUND (ABUS)
- Introduction
- Handheld ultrasound (HHUS) versus automated breast ultrasound (ABUS)
- Image acquisition, postprocessing and display
- Image interpretation
- Advantages and limitations of ABUS
- Clinical applications of ABUS: A literature review
- Future of ABUS
- Conclusion
- Diagnostic pearls
- 13.18.3. POSITRON EMISSION MAMMOGRAPHY
- Introduction
- Technique
- Positron emission mammography camera designs
- Clinical applications of PEM
- Advantages of PEM
- Limitations
- Conclusion
- Diagnostic pearls
- 13.18.4. MOLECULAR BREAST IMAGING
- Introduction
- Clinical indications
- Physical principle
- Technique
- Protocol
- Clinical applications
- Future directions
- Conclusion
- Diagnostic pearls
- 13.18.5. DEDICATED CONE-BEAM BREAST COMPUTED TOMOGRAPHY
- Introduction
- Development of CBBCT
- Technique
- Radiation dose
- Need for dedicated breast CT
- Clinical applications of CBCT
- Clinical advantages of CBBCT
- Diagnostic limitations
- Conclusion
- Diagnostic pearls
- 13.18.6. OPTICAL IMAGING
- Introduction
- Principle
- Domains of optical imaging
- Techniques
- Clinical applications
- Summary
- Diagnostic pearls
- 13.18.7. COMPUTER-AIDED DETECTION (CAD) IN BREAST IMAGING: HISTORY, CURRENT STATUS AND FUTURE
- Introduction
- Conclusion
- Diagnostic pearls
- 13.18.8. ARTIFICIAL INTELLIGENCE IN BREAST IMAGING
- Introduction
- AI in mammography
- AI in ultrasound
- AI in MRI breast
- Conclusion
- Diagnostic pearls
- Edition: 1
- Published: May 15, 2023
- Imprint: Elsevier India
- No. of pages: 917
- Language: English
- Hardback ISBN: 9788131263655
- eBook ISBN: 9788131263662
CA
C Amarnath
Affiliations and expertise
Professor and Head of Radiology, Stanley Medical College,Chennai, IndiaHP
Hemant Patel
Affiliations and expertise
Consultant Radiologist & Director, Gujarat Imaging Center,Ahmedabad, India