Publications

PUBLICATIONS IN INTERNATIONAL JOURNALS

1. Abnormal enhancement in a case of a relapsing polychondritis

A. Vourtsi, A. Papadopoulos, J. Xenellis, S. Golfinopoulos, L. Vlachos
Annals of Otology, Rhinology & Laryngology 1998 ;107 ;81-82
Relapsing polychondritis is a rare disease of unknown cause, first described in 1923 by Jaksch-Wartenhorst. It is characterized by an inflammatory reaction primarily involving the cartilage of the nose, ears, joints and upper respiratory tract and occasionally abnormalities of the cardiovascular system. Fifty percent of the patients present sensorineural hearing loss, which is usually reversible with steroid therapy. We describe a case of a middle-aged woman with relapsing polychondritis and vestibulocochlear manifestations. Although enhancement of the membranous labyrinth has been described in several pathologic conditions of the inner ear, this is the first reported case of this finding in relapsing polychondritis, to our knowledge.

2. Langerhans cell histiocytosis with involvement of the pons. Case report

A. Vourtsi, A. Papadopoulos, L. Moulopoulos, J. Xenellis, L. Vlachos
Neuroradiology 1998 ;40 :161-163
Central nervous system involvement is uncommon in Langerhans cell histiocytosis. The suprasellar region is more frequently affected. There have been few reports of involvement of the brain parenchyma shown on CT or MRI. We present a case of involvement of the pons, showing marked contrast enhancement on MRI.

3. Male breast myofibroblastoma and MR imaging finding. Report of a case

A. Vourtsi, D. Kehagias, A. Antoniou, A. Moulopoulos, E. Deligeorgi, L. Vlachos
Journal of Computer Assisted Tomography 1999 ;414-416
Myofibroblastoma of the breast is a rare benign tumor seen predominantly in men in the sixth to seventh decades of life. We present a case of breast myofibroblastoma in a man and describe the mammographic, sonographic and MR findings. To our knowledge, this is the only case of myofibroblastoma of the breast shown by MRI.

4. Comparison of CT, MRI and CT during arterial portography in the detection of malignant hepatic lesions

D. Kehagias, A. Metafa, A. Hatjiioannou, D. Mourikis, A. Vourtsi, A. Prahalias,
V. Smyrniotis, A. Gouliamos, L. Vlachos
Hepato-Gastroenterology 2000,47(35):1399-1403
A prospective study was performed to compare the sensitivities of CT, MRI and CT during arterial portography (CTAP) in the detection of focal malignant hepatic lesions. Twenty-eight (28) patients with primary and secondary hepatic malignant tumours were evaluated. All of these patients underwent hepatic resection and a lesion –to- lesion imaging pathological analysis was performed. The overall sensitivities were 53% for CT, 66% for MRI sequences and 88% for CTAP. For lesions smaller than 1 cm the sensitivities were 6% for CT, 17% for MRI and 72% for CTAP. The combination of CTAP and MRI yielded an overall detection rate of 93%. The difference between the sensitivity of CTAP and that of the other two imaging techniques was statistically significant (p<0.04) according to the McNemar test. CTAP demonstrated four false-positive lesions, two of which were correctly characterized by MRI and one by CT. In six patients (21.4%) the surgical plan was modified after CTAP. We concluded that, CTAP has the highest sensitivity and should be part of the preoperative examination. In some instances, the addition of MR imaging must be considered complementary in the preoperative diagnostic algorithm.

5. Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in Vitro fertilization and embryo transfer

A. Vourtsi, A. Antoniou, T. Stefanopoulos, E. Kapetanakis, L. Vlachos
European Radiology, 1999;9:1208-1213
The aim of this study was to evaluate the value of endovaginal color Doppler ultrasonography in the early diagnosis of ectopic pregnancy in women after in vitro fertilization and embryo transfer, and to correlate the sonographic findings with β-hCG serum levels. Thirty-five patients had proven ectopic pregnancies and 4 other patients had heterotopic pregnancies. The diagnosis was disclosed correctly in all cases by endovaginal color Doppler US by identifying an adnexal mass with placental flow and a nongravid uterus called a “cold uterus”. An intrauterine sac with “double ring sign” was found in all normal intrauterine pregnancies when the hCG levels exceeded 1000 IU/Ibut in none of the patients with ectopic pregnancy (EP). These findings suggest the efficacy of the discriminatory hCG serum level of 1000 IU/I in the investigation of EP. In conclusion, this studydescribes the diagnostic importance of transvaginal color Doppler US in correlation with hCG serum levels in the early detection of EP avoiding life threatening complications and improving patient outcome.

6. Hepatic epithelioid hemangioendothelioma: MR imaging findings

D. Kehagias, L. Moulopoulos, A. Antoniou, V. Psichogios, A. Vourtsi, L. Vlachos
Hepato-Gastroenterology 2000;47(36):1711-3

7. Bone Lesions with Soft-Tissue Mass: Magnetic Resonance Imaging Diagnosis of Lymphomatous Involvement of the Bone Marrow Versus Multiple Myeloma and Bone Metastases

L. Moulopoulos, M.A. Dimopoulos, A. Vourtsi, S. Gouliamos, L. Vlachos
Leukemia and Lymphoma 1999;34:179-184
Bone metastases from solid primary tumours, as well as multiple myeloma and secondary lymphoma may all present with bone lesions and associated soft-tissue masses on magnetic resonance images of the spine. In bone metastases and myeloma, the cortex of the affected bone is usually destroyed and a bulging contour is observed at the site of extraosseous spread. In cases of lymphomatous involvement of the bone marrow, however, we have observed that spread to the extraosseous soft-tissues occurs without alternation of the shape or contour of the affected bone. In order to assess whether this pattern of spread is indeed suggestive or even diagnostic of lymphoma of the bone marrow, we reviewed spinal bone marrow MR images of 66 patients, with bone metastases from solid primary tumours (33 patients), multiple myeloma (20 patients) and stage IV lymphoma with bone marrow involvement (13 patients), who had bone lesions and contiguous soft-tissue masses. If tumour was present of either side of the bony cortex but the contour of the affected bone was preserved, a “wrap-around” sing was diagnosed. A “wrap-around” sign was found in 12 of the 13 patients with lymphoma but in none of the patients with metastases or myeloma. On MR images of the bone marrow, the demonstration of tumours spread beyond the bony cortex without disruption of the outline of the diseased bone may favour the diagnosis of lymphoma more than that of metastases or multiple myeloma.

8. Rare cystic lesions of the abdomen and the pelvis: Imaging findings with pathologic correlation

D. Kehagias, E. Panourgias, A.C. Pafiti, L. Moulopoulou, A. Vourtsi, A. Gouliamos,
S. Trakadas, L. Vlachos
Hepato-Gastrenterology (In Press)
Cystic masses of the abdomen and the pelvis, originating from the mesentery, peritoneum and retroperitoneum are categorized into: a) congenital malformations, such as lymphangioma, enteric duplication cyst, enteric cyst, mesothelial cyst, lymphangioleiomyomatosis, cystic teratoma and retrorectal cyst hamartoma, b) inflammatory precesses, such as peritoneal echinococcus infection, c) benign tumours such as cystic mesothelioma and mucinous cystadenoma, d) malignant tumours such as peritoneal leimyosarcomatosis, malignant cystic fibrous histiocytoma, pseudomyxoma peritonei, peripheral primary neuroectodermal tumors, liposarcoma and cystic metastases and finally, e) other entities such as intramural bowel haemorrhage, appendiceal mucocele and nonpancreatic pseudocyst. In this article we present the imaging findings of these cystic appearing lesions correlated with the pathologic features. Although the radiologic findings are in many cases informative, in the majority of cases imaging findings are non-specific. Definite diagnosis of cystic masses of the abdomen and pelvis is often difficult and requires histologic confirmation.

9. Liver invasion by recurrent granulosa cell tumour of the ovary: MR imaging findings

D. Kehagias, A. Vourtsi, L. Moulopoulos, E. Karvouni, L. Vlachos
European Journal of Obstetrics & Genecology
and Reproductive Biology 2000;89:63-67
Granulosa cell tumour of the ovary is a rare neoplasm of low malignant potential, late recurrences, local spread and high survival rates. We report the MR imaging appearance of invasion of the liver parenchyma by recurrent granulosa cell tumour of the ovary 15 years after initial diagnosis.

10. False negative mammogram

A. Vourtsi, F. Petrogiannis, X. Papacharalampous, A. Gouliamos, L. Vlachos
Where we Stand with Breast Cancer,
1999 Edited by Niki J. Agnantis, D.D. Tsiftsis
Although mammography is a valuable tool for the detection of breast cancer at an early or preclinical stage, something which results in the decrease of breast cancer deaths, still, a false negative mammogram remains a matter of deep concern.The factors which may affect a false negative mammography are the following: a benign o probably benign appearance, lesions visualized on only one of the two standard views, a location where visualization is difficult, mammographically occult breast lesions and interpretation error. A better understanding of these factors would enable a decreased percentage of the sequellae from a false negative mammographic study. This study investigates representatives cases of a false negative mammography and explains the significant traits which will help obviate a false negative mammographic reading. Mammographer can reduce the number of false negative mammographic readings by updating equipment, technical quality, and interpretation skills. However, it should be kept in mind that, in the presence of suspicious clinical findings, mammography is not a substitute for biopsy.

11. CT appearance of solitary and multiple cystic and cavitary lung lesions

Α. Vourtsi, A. Gouliamos, L. Moulopoulos, X. Papacharalampous, A. Chatziioannou,
D. Kehagias, N. Lamki
European Radiology 2001;11:612-622
Cystic and cavitary lung lesions constitute a spectrum of pulmonary diseases diagnosed in both children and adults. We have reviewed the computed tomographic (CT) findings of the most common cystic and cavitary lesions and we have defined useful morphologic criteria that will help radiologists to distinguish benign from malignant cavitary lesions. However, in many cases the considerable overlap in morphologic features of benign and malignant cavities, renders transthoracic needle biopsy necessary to establish the correct diagnosis.

12. Breast pain and mammographic density increase as a consequence of raloxifene therapy

G.E. Christodoulakos, I.V. Lambrinoudaki, A.D. Vourtsi, K.P. Panoulis, G.C. Creatsas
Journal of Endocrinological Investigation 25:564-566, 2002
A 55-yr-old post-menopausal woman with osteopenia and no history of breast disease is presented. She was placed on raloxifene HCI 60 mg and soon after developed severe breast pain. The follow-up mammogram, performed prematurely at 6 months, showed a marked increase in breast density. Therapy was accordingly stopped and mastodynia subsided. The patient’s mammogram regressed to pre-treatment status after 6 months off-therapy.

13. The effect of various regimens of hormone replacement therapy on mammographic breast density

George E. Christodoulakos, Irene V. Lambrinoudaki, Konstantinos P.C. Panoulis,
Athina D. Vourtsi, L. Vlachos, E. Georgiou, George C. Creatsas
Maturitus 45 (2003) 109-118
Objectives: To evaluate the effect of three distinct hormone replacement therapy regimens on mammography.

Methods: 121 postmenopausal women who had never received or were past users of hormone replacement therapy were studied prospectively. Women with an intact uterus were randomly allocated either to conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, n=34) or to 17β-estradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA, n=35). Hysterectomized women received CEE 0.625 mf (CEE, n=25). Women who either declined or did not qualify for treatment served as controls (n=27). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month-mammograms.

Results: No increase in breast density was identified in any of the women in the control group. Two women (8%) in the CEE group showed an increase in breast density. Four women (11.8%) in the CEE/MPA and 11 women (31.4%) in the E2/NETA group revealed an increase in breast density. No woman in the therapy groups showed an involution of fibroglandular tissue while seven women (25.9%) in the control group exhibited involution of breast parenchyma.

Conclusions: Our study suggests that hormone replacement therapy may suspend breast involution but does not increase breast density in the majority of patients. In the minority of patients who show a density increase, the magnitude of this increase varies according to the regimen employed.

Keywords: Hormone replacement therapy; Mammography; Breast density

14. Mammographic changes associated with raloxifene and tibolone therapy in postmenopausal women: a prospective study

George E. Christodoulakos, MD, Irene V. Lambrinoudaki, MD, Athina D. Vourtsi, MD, Konstantinos P.C. Panoulidis, MD, Dimitrios A. Kelekis, MD, George C. Creatsas, MD, FACS
Menopause: The Journal of The North American Menopause Society Vol 9,
No 2, pp. 110-116, 2002
Objective: The prolonged use of estrogen therapy is associated with a slightly increased risk of breast cancer. Alternative therapies that are effective in the prevention of menopause, having associated morbidities but no unwanted effects, are of primary interest in the pharmacologic research. The aim of this study was to evaluate the effect of two alternatives to estrogenes drugs, the selective estrogen receptor modulator raloxifene and the tissue-specific tibolone, on the mammographic appearance of the breast.

Design: The study group comprised 131 postmenopausal women aged 41 to 67 years. The women were at least 2 years postmenopausal, free of climacteric symptoms, and at the time of entry to the study had not had therapy for at least 9 months. Women with risk factors for osteoporosis or cardiovascular disease were allocated either to tibolone(n=56) or raloxifene (n=48) therapy. Women with no risk factors and women who either did not qualify for or denied treatment (n=27) served as controls. The study duration was 12 months. Women received a baseline mammogram before commencing therapy and a repeat mammogram at the end of the study period. Mammogram findings were classified according to the modified Wolfe criteria by two expert radiologists.

Results: No difference was identified between groups with respect to baseline characteristics associated with breast cancer risk. Similarly, no difference was detected between groups concerning the modified Wolfe classification of baseline mammographic findings. In the tibolone group, 10.7% of the women showed an increase in breast density in the 12-month reevaluation. The respective figure in the raloxifene group was 6.3%, whereas no woman in the control group showed an increase in breast density. Differences in the increase in breast density between groups did not, however, reach statistical significance. Accordingly, 10.7% of women in the tibolone group and 18.8% of women in the raloxifene group exhibited involutionary changes in the repeat mammogram, whereas 25.9% of women in the control group revealed a decrease in breast density in the 12-month examination. The percentages were not significantly different between groups.

Conclusions: Breast density as shown by mammography was stable in a majority of patients and changed in a minority of cases for both tibolone and raloxifene. In most patients, these drugs are not likely to interfere with mammogram interpretation. Larger long-term studies are needed to confirm the impact of prolonged tibolone or raloxifene administration no mammography.

Keywords: Mammographic density – Estrogen therapy – Tibolone – Raloxifene

15. The effect of low dose hormone therapy on mammographic breast density

G.E. Christodoulakos, I.V. Lambrinoudaki, A. Vourtsi, S. Vlachos, M. Kreatsa, K. Panoulis, D. Botsis
Accepted for publication in Maturitas (09/2005)
Objectives: To evaluate the effect of two standard and one low dose continuous hormone therapy regimens on mammography.

Methods: 132 non-hysterectomized postmenopausal women were randomly allocated either to conjugated equine estrogens 0.625mg plus medroxyprogesterone acetate 5mg (CEE/MPA, n=38 ), 17β-estradiol 2mg plus norethisterone acetate 1mg (E2/NETA, n=44) or 17β-estradiol 1mg plus norethisterone acetate 0,5mg (low E2/NETA , n=50). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month-mammograms.

Results: 5 (13.2%) women in the CEE/MPA group showed an increase in breast density. 14 (31.8%) women on E2/NETA and 6 (12.2%) on low E2/NETA treatment revealed an increase in breast density. No woman exhibited an involution of fibroglandular tissue.

Conclusions: Different hormone therapy regimens have a variable impact on breast density probably depending on the steroid used. Low dose hormone therapy associates with significantly lesser increase in breast density.

Keywords: low dose hormone therapy, mammography, breast density

16. Male Breast Hemangioma

A. Vourtsi, S. Zervoudis, A. Pafiti, S. Athanasiadis
Accepted for publication in The Breast Journal 12(3) May June 2006
Abstract: Hemangioma is a very rare breast tumor and their association in a male breast is, in fact extremely rare. A case of breast hemangioma in a 77-year-old male patient is presented with description of the mammographic and pathologic findings.

Index Terms: Hemangioma – Male Breast – Mammography

Hemangioma of the male breast is an extremely rare benign vascular tumor and information regarding its mammographic appearance is not available. Only one case of hemangioma in a male breast is reported in the literature, in which only the pathologic findings are described [1]. The present paper describes the mammographic and pathologic findings of a male breast hemangioma.

17. The effect of low dose hormone therapy on mammographic breast density

George E. Christodoulakos, Irene V. Lambrinoudaki, Athina D. Vourtsi, Sofia Vlachou, Maria Creatsa, Konstantinos P.C. Panoulis, Dimitrios Botsis
Maturitus 54 (2006)78-85
Objectives: To evaluate the effect of two standard and one low dose continuous hormone therapy regimens on mammography.
Methods: One hundred and thirty-two non-hysterectomized pοstmenopausal women were randomly allocated either to conjugated equine estrogens 0.625mg plus medroxyprogesterone acetate 5mg (CEE/MPA, n=38) 17β-estradiol 2mg plus norethisterone acetate 1mg (E2/NETA,n=44) or 17β-estradiol 1mg plus norethisterone acetate 0.5mg (low E2/NETA, N=50). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and 12-month mammograms.
Results: Five (13.2% women in the CEE/MPA group showed an increase in breast density. Fourteen (31.8%) women on E2/NETA and 6 (12.2%) on low E2/NETA treatment revealed an increase in breast density. No women exhibited an involution of fibroglandular tissue.
Conclusion: Different hormone therapy regimens have a variable impact on breast density probably depending on the steroid used. Low dose hormone therapy associates with significantly lesser increase in breast density.

18. Breast cancer as a major health issue and the role of mammography in early diagnosis
A. Vourtsi – Hellenic Breast Imaging Society
This position paper on screening for breast cancer (BC) has been proposed by the Executive Board and the Scientific Committee of the European Society of Breast Imaging (EUSOBI) and approved by 30 national breast radiology bodies/sections. The aim is to give a clear message in favour of screening mammography to national/local governments, policy makers, referring physicians and the general population. Among the 30 national breast radiology bodies who signed a Memorandum of Understanding with the European Society of Breast Imaging and co-authored this paper, the Hellenic Breast Imaging Society.
Breast cancer as a major health issue and the role of mammography in early diagnosis“.

19. Breast Imaging and Health Care in Greece
A. Vourtsi
Did you know that the incidence of breast cancer is Greece in lower than in Northern Europe and the United States? Dr. Athina Vourtsis writes about screening and breast health awareness in her article “Breast Imaging and Health Care in Greece“. The article is also reprinted in Greek. http://www.pageturnpro.com/Society-of-Breast-Imaging/78574-SBI-17-07-SBI-2017-Issue-2-DigiNews-ePub_FINAL/default.html#page/10

 

20. Using 3D ABUS to achieve improved breast care outcomes. Breast imaging expert panel

Dr. Athina Vourtsis, MD, PhD, Radiologist
How is screening handled in countries that do not have a national regulated Breast Cancer Screening program?
How did you decide to offer 3D ABUS for women with dense breasts? What are the clinical advantages of using 3D ABUS?
How does the 3D ABUS coronal view help solve the problem of architectural distortions?
What are the workflow advantages of using 3D ABUS compared to HHUS?
How do you educate your patients about breast density and supplemental ABUS screening? What should patients know?
What do you see as the next steps to set a standard of care for screening women with dense breasts?

Using 3D ABUS to achieve improved breast care outcomes

 

21. The performance of 3D ABUS versus HHUS in the visualization and BI-RADS characterization of breast lesions in a large cohort of 1.886 women.

Athina Vourtsis & Aspasia Kachulis

The study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions.

3D ABUS performance vs. HHUS in the visualization and BI-RADS characterization of breast lesions

 

22. Screening for High-Familial-Risk Women

Dr. Athina Vourtsi

Women with a high familial breast cancer risk have an increased likelihood of developing breast cancer and a subsequent increased risk of developing contralateral malignancy. Therefore, additional surveillance has been recommended to reduce risks.

Screening for High-Familial-Risk Women

 

INTERNATIONAL CONFERENCES – MEETINGS

1. The value of Gd-Enhanced MRI in the Investigation of Sudden Hearing Loss

A. Papadopoulos, A. Vourtsi, N. Kanelis, L. Vlachos, J. Xenelis,
B. K. Papafragou, G. Adamopoulos
Roentgen Centenary Congress Birmingham, England 1995
Recent reports describe labyrinthine enhancement as a highly specific sign of labyrinthine disease, but the sensitivity of this finding has not been reported. In a prospective study we investigated 59 patients with sudden sensorineural hearing loss to elucidate the role of Gd-enhanced MRI in depicting labyrinthine damage. We studied 59 patients with sudden sensorineural hearing loss of less than 1 month duration. Clinical and laboratory evidence of damage at the cochlear level were present in all patients. MR-examinations were performed on a 0.5T scanner, SE T1 weighted axial and coronal images of the petrous bones were obtained before and after administration of GD-DTPA. Enhancement of the membranous labyrinth was observed in only on e patient with a cochlear schwannoma that extended into the fundus of the internal acoustic canal. In two more patients MRI demonstrated causes of their sudden hearing loss: a case of large vestibular aqueduct syndrome and an acoustic neuroma of the cerebellopontine angle. Although specific, labyrinthine-enhancement seems to be an infrequent sign in cases of labyrinthine disease. However, imaging of the acoustic pathway is necessary in patients with sudden cochlear hearing loss, as audiologic testing may fail in localizing the pathological lesion precisely.

2. The Value of Color Doppler Flow Sonography in Depicting the Post-operative

L. Livieratos, G. Zavras, A. Vourtsi, G. Theodorakopoulos, B. Andrikopoulos,
A. Psaroudakis, P. Panousis
International Congress of Phlebology Corfu, Greece 1996
A prospective study was conducted with color – flow Doppler sonography to document remnants for the LSV and perforating veins after surgical management of the long saphenous vein. Fifty-nine limbs in 55 consecutive patients with excision of the long saphenous vein were studied. They were all out patients and their major complaint was persistent pain in the medial aspect of the leg extending to the ankle. The following branches of the LSV and perforating veins were identified: Deep branch of the tibia in 8 limbs, anterior branch in the femur in 12 limbs, anterior branch in the tibia in 15 limbs, posterior branch in the tibia in 13 limbs, both the anterior and posterior branches in the tibia in 9 limbs, 3 pairs of incompetent deep perforating veins were found proximal to the knee, 21 pairs of incompetent deep perforator veins were detected in the proximal portion of the tibia and finally venous insufficiency of the superficial system was present in 42 limbs. These data suggest that color-flow Doppler sonography is an efficient and accurate method for depicting post-operative remnants of the LSV and popliteal veins, and should be used in routine base for pre-operative mapping of the long saphenous vein.

3. Correlation of Thrombosis Between Superficial Femoral Vein (SFV), Common Femoral Vein (CFV) and Popliteal Veins (Pvs).A Follow-up Study With Duplex Scanning

L. Livieratos, G. Zavras, A. Vourtsi, S. Pantou, C. Haritidis, M. Christoforidis, P. Panousis
International Congress of Phlebology Corfu, Greece 1996
The purpose of this study was to evaluate the incidence of SVG thrombosis in patients with thrombosis in the CFV and popliteal veins. One hundred twenty two limbs in 61 patients were examined by Duplex Ultrasonography including forty-seven limbs with fractures of the femur and tibia. The patients were classified in 3 groups on the basis of the site involved (thrombosis of the common femoral vein, the popliteal vein and of both the common femoral and the popliteal veins). In the initial examination Deep Vein Thrombosis (DVT) was diagnosed in 89 limbs, in the rest 33 limbs thrombosis was not identified. Thirty-seven limbs had common femoral vein thrombosis which also involved the superficial femoral vein. Twenty-five limbs had thrombosis of the popliteal vein. Twenty-seven limbs had common femoral vein thrombosis which also involved the superficial femoral vein. Twenty-five limbs had thrombosis of the popliteal vein. Twenty-seven limbs presented with thrombosis of both the common femoral and the popliteal veins. There is a high incidence of superficial femoral vein thrombosis that accompanies the thrombosis of the common femora and popliteal veins. Thereforethe evaluation of the SFV, should be avoided in patients with trauma or fractures of the lower limb with thrombosis of CFV and PVs.

4. Transthoracic Fine Needle Aspiration Biopsy (TFNAB) of Small Pulmonary Nodules

M. Tzalonikou, A. Vourtsi, M. Kousaris, D. Farsaris, V. Dendropoulou, A. Moulopoulou,
A. Kalovidouris, A. Gouliamos, L.Vlachos
7th European International Symposium Organized by the Aristoteles Institute; Thessaloniki, Greece 1997
The aim of this study is to evaluate the accuracy of TFNAB in patients with small pulmonary nodules and to determine the percentage of malignancy in this group of patients. Patients with solitary or multiple pulmonary nodules less that 3cm in diam were selected. The site of the lesion was localized under Ct-guidance. A 19-22G fine needle was used for aspiration. In 41.66% of the cases malignancy was diagnosed. In 5% the pathologic findings were considered suspicious for malignancy. The percentage of lesions of benign etiology was 23.33%. In the remainder 30% of the cases no definite diagnosis could be obtained from the study of the pathologic specimen. CT-guided biopsies by TFNAB can produce diagnostic accuracy comparable with published results of the method in larger pulmonary lesions.

5. Transthoracic Fine Needle Biopsy of Peripheral Lung Lesions

M. Tzalonikou, A. Vourtsi, M. Kousaris, D. Farsaris, A. Moulopoulos, A. Kalovidouris,
A. Gouliamos, L. Vlachos
7th European International Symposium Organized by the Aristoteles Institute; Thessaloniki, Greece 1997
This is retrospective study of 62 cases with peripheral lung lesions and previous non diagnostic bronchoscopy. Criteria for patient selection included: 1) broad angle to the pleura lung lesions 2) narrow-angle to the pleura lung lesions, 3) subpleural nodules. The lesion was localized under CT-guidance and were punctured by fine needle (19-22G) for aspiration of cellular material. The percentage of positive results for malignancy, primary or secondary was 59.7% (37 out of 62 cases). In the remaining 40.3% benign lesions were diagnosed. Fine needle aspiration (FNA) under CT guidance, is extremely helpful in the diagnosis of peripheral malignant lesions and facilitate the diagnostic work-up.

6. Ectopic Pregnancy in Women at High Risk: Diagnostic Value of Endovaginal Sonographic Findings Correlated with Human Chorionic Gonadotropin Levels.

T. Stefanopoulos, A. Vourtsi, A. Antoniou, M. Tzalonikou, K. Kapetanakis, A. Papadopoulos, L. Vlachos
European Congress of Radiology; Vienna, Austria 1997
The purpose of this study was to determine the value of endovaginal color and duplex sonography in the early diagnosis of ectopic pregnancy (E.P.) in women at high risk and to correlate the sonographic findings with serum drawn for measurement of human chorionic gonadotropin (hCG) and progesterone levels. During a 2 ½ year period (January 1994 – July 1996) we studied a group of 300 pregnant women after assisted reproduction as early as 3-4 weeks after conception. All patients had serum drawn for measurement of hCG and progesterone levels and studied endovaginally using color duplex sonography. Of the 300 women studied 39 had an ectopic pregnancy. The diagnosis of E.P. was based on real-time findings as well as on the recognitionof placental blood flow on color duplex sonography. Patients with positive scans were referred for laparoscopy. In all patients with EP, hCG values were above 1000mIU/Ml and progesterone levels increases the diagnostic sensitivity to 100% in the early scanning of a population at increased risk for EP.

7. Cholesterol Polyps of the Gallbladder Wall Less Than 2cm: Review of 12 years

M. Tzalonikou, A. Antoniou, A. Vourtsi, A. Pafiti, G. Polymeneas, E. Kapsalaki
European Congress of Radiology; Vienna, Austria 1997
The purpose of this study was to review the clinical, ultrasonographic and histopathological features of cholesterol polyps less than 1 cm in 3.500 patients. Seventy thousand patients underwent abdominal ultrasound examination in our institution over a 12-year period. 3.500 patients were found to have polypoid lesions of the gallbladder smaller than 1 cm in diameter. In 60% of the cases more than one lesion was found. In most of the cases (80%) there was no correlation to clinical symptoms and was an incidental finding. In 70% of the cases various types of hyperlipidemia coexisted. 144 patients underwent cholecystectomy. 81 patients were followed at regular time intervals in the group of surgically and histologically proven 144 cases, gallstones coexisted in 70% of the cases, single cholesterol polyp in 80% and multiple in 20%. In this group 40% of the patients developed gallstones at different time intervals (5-8 years). In two cases a true adenoma was found. 81 cases are followed over a period of 12 years and no significant change in the number and diameter of the lesions was found. Simple or multiple cholesterol polyps of less than 1 cm is usually an incidental finding, which is found in hyperlipidemic patients.

8. The Value of Gd-DTPA Enhanced MR Imaging in Patients with Unilateral Hearing loss

A. Vourtsi, A. Papadopoulos, J. Xenelis, N. Kanelis, K. Papafragou, A. Antoniou, L. Vlachos
European Congress of Radiology; Vienna, Austria 1997
The purpose of this study was to assess the role of Gd-enhanced MRI in patients with unilateral sensorineural hearing loss (SNHL). Sixty-five consecutive patients with an audiologically confirmed unilateral sensorineural hearing loss were included in the study. MR-examinations were performed on a 0.5 T scanner. First the patients underwent axial SE PD T2-W and sagittal SE T1W images of the whole brain in order to exclude retrocochlear lesions. SE T1W axial and coronal images of the petrous bones were obtained before and after administration of Gd-DTPA. The most common finding was multiple high-signal intensity lesions located in the white matter of the brain, found in 8 patients. They were attributed to microvascular leukoencephalopathy in 6 patients and demyelinating disease in 2 patients. In another patient with documented Langerhans cell histiocytosis a mass like lesion was demonstrated in the pontine region. Enhancement of the membranous labyrinthwas observed only on post-Gd images in two patients with a cochlear schwannoma and relapsing polychondritis respectively. We believe that the use of Gd-DTPA increases the capability of MR imaging for detecting lesions along the acoustic pathway especially those located in the membranous labyrinths and IACs and we would suggest that in patients with complex presentation G-d enhanced MR images should always be obtained.

9. The “Wraparound” sign: A Telltale Sign of Lymphoma of the Bone Marrow?

A. Vourtsi, L. Moulopoulos, A. Gouliamos, A. Kalovidouris, L. Vlachos
European Congress of Radiology; Vienna, Austria 1997
Secondary lymphomatous involvement of the spine may manifest as diffuse or focal marrow abnormality on spinal MR images. Extraosseous mass is often present. We have observed that, when paraspinal mass is present on MR images, the vertebral cortex, though enveloped by tumor, maintains its architecture without obvious signs of destruction. The purpose of this presentation is to illustrate this observation. We present 8 patients (7 men, 1 woman, age range 2-80 years) with biopsy proven secondary lymphoma of the marrow and spinal MR images. Five patients had diffuse and 3 had focal MR patterns of marrow involvement. All patients had paraspinal masses. In each patient, extraosseous tumor was “wrapped” around an apparently intact cortex. The “wraparound” MR sign is infrequently observed in patients with bone metastases. We believed that its presence in patients with lymphoma of the bone marrow reflects the permeative nature of lymphoma and that, when present, it should raise the possibility of this disease.

10. Benign vs. Malignant Cavitary Lung Lesions: Is it possible to be Distinguished by CT?

A. Vourtsi, M. Kousaris, L. Moulopoulos, A. Kalovidouris, A. Gouliamos, L. Vlachos
2nd Mediterranean Congress on Thoracic Diseases, Athens, Greece 1998
The aim of our study was to evaluate the CT characteristics of cavitary lung lesions and to attempt differentiation of benign from malignant lesions. We reviewed retrospectively 35 patients with solitary and multiple lung cavitary lesions. Of those 17 were malignant and 18 benign. Measurements of the thickness of the cavity wall and evaluation of the outer and inner margins were made on CT images. The precence of short tissue mass, intrapulmonary satellite lesions, infiltration of the thoracic wall and enlarged mediastinal lymph nodes were analyzed and compared with the histological findings. From the results of our study we found a higher incidence of a thin cavity wall, smooth inner and outer margin contour and intrapulmonary satellite lesions in benign cavities. A thick wall with irregularities in its border associated with or without a speculated soft tissue mass, infiltration of the thoracic wall and enlarged mediastinal lymph nodes were more frequent in malignant lesions. In conclusion although the radiological findings of cavitary lesions in 80% of cases suggested a benign of malignant etiology the clinical history and histological examinations remains
necessary in establishing the correct diagnosis.

11. Can MRI Suggests the Diagnosis in Lesions of the Temporal Bone?

A. Papadopoulos, A. Vourtsi, M. Douskou, E. Georgiadis, V. Vantali, C. Drossos
European Congress of Radiology; Vienna, Austria 1999
MRI has evolved as the imaging modality of choice in the evaluation of patients with sensorineural hearing loss. Uncommon lesions of the temporal bone may be demonstrated, with which the radiologists are not familiar yet. The purpose of this exhibit is to demonstrate the MR findings in some of these conditions. Two hundred and fifty MR examinations of the petrous bones were performed during the last two years. The imaging protocol consisted of axial SE PD/T2-W images of the brain and axial and coronal SE T1-W pre- and post-Gd and thin slice FSE T2-W images of the petrous bone. CT is available in most patients presented here. Lesions of the external and middle ear, membranous labyrinth and internal acoustic canal without involvement of the surrounding bony structures were excluded from the study. Presented are two cases of active otospongiosis, one of fibrous dysplasia, one with Paget disease, one chondrosarcoma, two cholesterol granuloma, one glomus jugulare tumor and two retention cysts. MRI may demonstrate specific findings in pathological conditions with involvement of the temporal bone. Familiarity of the radiologist with the radiologist with the imaging characteristics of these lesions will facilitate the correct diagnosis and obviate a further CT examination.

12. The Role of Transvaginal Sonohysterography in the Assessment of the Uterine Cavity in Patients with Fertility Problems
του μαστού

A. Vourtsi, T. Stefanopoulos, A. Antoniou, D. Kehagias, E. Kapetanakis, L. Vlachos
European Congress of Radiology; Vienna, Austria 1999
The purpose of this study was to evaluate the role of transvaginal sonohysterograhy in the assessment of uterine abnormalities in infertility patients. Transvaginal sonohysterography was performed in 43 patients (aged 32-47 years) in whom conventional transvaginal sonography suggested intrauterine abnormalities either by endometrial thickening or abnormal morphology. In all cases the examination was performed by placing a small catheter into the endometrial canal and injection of 5-10cc of saline solution under sonographic visualization. Transvaginal sonohysterography depicted endometrial polyps (n=10), intracavitary fibroids (n=13), endometrial thickening (n=8), carcinoma (n=1) and normal cavities (n=11).
All patients underwent diagnostic hysteroscopy and in 1 case hysterectomy was performed. All findings diagnosed with tranvaginal sonohysterography corresponded to the results observed with hysteroscopy and hysterectomy. No complications occurred. In conclusion transvaginal sonohysterography using saline solution injected is a low-cost, easy and very sensitive procedure in the assessment of the uterine cavity, and we believe it should be the primary examination in evaluating patients with fertility problems.

13. Νεώτερες απεικονιστικές μέθοδοι στην διαγνωστική προσέγγιση παθήσεων του μαστού

A. Vourtsi, F. Petrogiannis, X. Papacharalampous, A. Gouliamos, L. Vlachos
Hellenic Society for Breast Cancer Research, Crete, Greece 1999
The purpose of this study is to review the mammographic appearance of various causes of a false negative mammography. A series of 16 false negative mammograms were retrospectively analyzed. The factors affecting the false negative mammography are classified into 1) benign or probably benign appearance, 2) lesions visualized on only one of the two standard views, 3) location where visualization was difficult, 4) mammographically occult breast lesions and 5) interpretation error. This exhibit illustrates representative cases of a false negative mammography and explains the significant traits that help obviate a false negative mammographic reading. In conclusion any indirect signs of malignancy scrupulously observed together with the optimization of radiographic technique and clinical findings are imperative in order to reduce the rate of a false-negative mammographic study.

14. Uncommon causes of sensorineural hearing loss: MRI appearance

A. Papadopoulos, A. Vourtsi, V. Maniatis, C. Sumara, S. Kavadias, K. Strigaris, L. Vlachos
XXV Congress and 9th Advanced Course of Neuroradiology
Vienna, Austria 1999
Idiopathic cases with no imaging findings of acoustic neuroma constitute the vast majority among patients with sensorineural hearing loss (SNHL). Demonstration of uncommon lesions responsible for SNHL is the purpose of this study. Over a period of 36 months, 146 patients with SNHL were examined. Axial SE T2-W images of the brain and axial and coronal pre- and post-Gd SE T1-W images of the petrous bonewere obtained. Complete audiologic and electronystagmographic studies were available. Patients with acoustic neuromas and meningeomas of the CPA were excluded form the study. MRI findings responsible for SNHL were visualized in ten patients: Two cases with secondary deposits in the IAC, one cochlear schwannoma, one case of pontine Langerhans cell histiocytosis, one case of autoimmune labyrinthitis one patient with relapsing polychondritis, one case of a large vestibular aqueduct syndrome, two cases of active otospongiosis, one case with Paget disease, and one with fibrous dysplasia. In conclusion, uncommon lesions of the petrous bone, membranous labyrinth and retrocochlear acoustic pathway may cause SNHL. MRI can suggest the correct diagnosis, and familiarity of the radiologist with the appearance of these conditions is mandatory.

15. Mammographic appearance of uncommon breast lesions

A. Vourtsi, G. Panagi, A. Gouliamos, F. Petrogiannis, D. Kehagias, L. Vlachos
European Congress of Radiology Vienna, Austria March 2000
The purpose of this exhibit is to present the radiologic findings of unusual conditions of the breast. We retrospectively assessed the radiologic findings in 15 patients diagnosed with uncommon breast lesions examined during January 1998 and August 1999. Patients were examined with mammography in conventional projections (n=15) and US (n=4). In 11 patients fine-needle aspiration biopsy (FNAB) was performed and surgery followed. Diagnosis included primary non-Hodgkin lymphoma (n=1), phyllodes tumors (n=4, tubular carcinoma (n=2), xanthomatous nodule (n=1), lipophagic granuloma (n=1), intraductal papilloma (n=1), radial scar (n=2), hamartoma (n=2), silicone granulomas (n=1) and reconstructed breast with a rectus abdominis musculocutaneous flap (TRAM) (n=1). In conclusion radiological awareness of unusual lesion characteristics allows the mammographer to set the grounds for the diagnosis with higher confidence.

16. Wertigkeit bildgebender Verfahren (US, MRT) bei Schulterge lenkerkrankungen klinische und operative korrelation.

Papacharalampous, X. Maris, J. Beck, A. Mundiger, A. Vourtsi, Papageorgiou A,
Vlahos L, Langer M.
RSNA 2000, 86th Scientific Assembly Chicago, Illinois, USA

17. Vergleich bildgebender Verfahren bei Milzveranderungen

Deutsche Rontgengesellschaft Wiesbaden, Germany 2000
Ιατρικά Ανάλεκτα, Θεραπευτηρίου Υγεία Τεύχος 21,
Ιουλίος-Σεπτεμβριος 2003

18. Doppler Perfusion Index in Benign and Malignant Liver Tumors

K. Kyriakopoulou, MD, Athens, Greece A. Vourtsi, MD, A.G. Antoniou, MD, E. Iliopoulou, MD, S. Lahanis, MD, S.J. Trakadas, MD
RSNA 2000, 86th Scientific Assembly Chicago, Illinois, USA
PURPOSE: To evaluate the Doppler Perfusion Index (DPI) of the liver in detecting benign and malignant hepatic lesions. METHOD AND MATERIALS: Sixty-eight patients (age 30-77y) after a 12 hours fasting period, had a liver Doppler sonogram. The common hepatic artery (HA) and the portal vein (PV) flow volume was recorded and the DPI of the liver was calculated as the ratio {HA flow volume}/{HA+PV FLOW VOLUME}. All patients had either an upper abdominal dual-phase spiral CT scan or a MRI scan of the liver. Forty-eight patients found to have benign tumors (26 solitary hemangiomas, 1 hypoechoic hemangioma, 1 hepatic abscess, 2 hepatic adenonas, 2 multiple hemangiomas, 10 cavernous hemangiomas, 1 hydatic cyst, 5 focal nodular hyperplasias) and 20 patients malignant tumors, (1 cholangiocarcinoma, 1 hepatoma, 18 metastases-7 ca breast, 1 ca esophageal, 1 carcinoid ca, 3 unknown primary, 2 lung ca, 4 colorectal carcinoma).
RESULTS: There was a significant increase, in the cross-sectional area and the blood velocity in the hepatic artery in the patients with overt hepatic metastases. Both the cross-sectional area and the time averaged mean velocity of the portal vein was
reduced in the group with confirmed hepatic involvement. The portal venous blood flow was also significantly reduced in the group with metastases. None of the above parameters correlated with age. In all cases with benign liver lesions the DPI value range was 0.10-0.16 in the males and 0.10-0.18 in the females with the exception of the hydatid cyst. In this case the DPI was 0.28. In the malignant liver lesions the DPI value range was 0.53-0.63 in the males and 0.52-0.62 in the females. The DPI measurements were independent of the size, the number and the location of the liver lesions. Spiral CT, MRI or Real Time Ultrasonograms were diagnostic for the hemangiomas, the primary and the metastatic tumors. In seven (7) cases biopsy was performed to establish the diagnosis of the FNH and multiple adenomas. CONCLUSIONS: Doppler Perfusion Index measurements may be used in the differential diagnosis of hepatic lesions as an adjunct to Real Time and Color Doppler ultrasound.

19. Paraffinomas of the breast: Mammographic, ultrasonographic and MR apperances with histopathological correlation

D. Vourtsi*, A.D. Kelekis**, M. Kousaris***, L. Moulopoulos***, K. Kyriakou*
*Breast Department of Hygeia Diagnostic & Therapeutic Center
**B Laboratory of Radiology, University of Athens, Evgenideio Hospital
***Department of Radiology, Aretaeion Hospital, University of Athens
HSBCR 5TH International Congress November 2001, Athens Greece
Purpose: The purpose of the study is to evaluate the mammographic, ultrasonographic and MR appearances of breast paraffinoma, a late complication of breast augmentation, by direct injection of liquid paraffin wax into the breast.
Methods: Five women ranged in age from 34-42 years old with a history of paraffin oil injection for breast augmentation underwent Mammography, Sonography and MR imaging. A Sigma 1.5 – T clinical whole body image was used with a dedicated breast coil (General Electric Medical Systems). Results: On mammography paraffinomas appear as dense streaky opacities causing bizarre architectural distortion while of sonography, marked acoustic shadowing associated with dense fibrosis is noted. On T1-Weighted and T2-Weighted sequences paraffinomas appear with low signal intensity. On contrast enhanced T1-Weighted Fat suppressed sequences, paraffinomas appear markedly hypointense to fibroglandular tissue. Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes.
Conclusion: Although useful for the diagnosis of paraffinomas, neither Mammography nor Sonography can be used to evaluate the surrounding breast tissue. We found that breast paraffinomas have characteristic MR appearance that correlates well histopathologic findings. In addition, MR imaging appears to be the best imaging technique for demonstrating the extend of paraffinomas and for detection of breast carcinoma in the surrounding breast tissue.

20. The effect of various forms of hormone replacement therapy on the mammographic appearance of the breast

G. Christodoulakos, I. Lambrinoudaki, A. Vourtsi, C. Panoulis, L. Vlachos, G. Creatsas
2nd Department of Obstetrics and Gynekology, University of Athens, Aretaeion Hospital, Athens, Greece Amsterdam Menopause Symposium 2001
OBJECTIVE: to evaluate the effect of various regimens of hormones replacement therapy on the mammographic appearance of the breast in postmenopausal women over one year of therapy in comparison to mammograms of women receiving no therapy.
MATERIAL AND METHODS: The study group consisted of 121 postmenopausal women aged 38 to 66 years. Women were at least 2 years postmenopausal and either had never received HRT or were off-HRT for at least 9 months. Ninety-four women with climacteric complaints or risk factors for cardiovascular disease or osteoporosis received HRT. The remaining 27 women who either declined or did not qualify for HRT served as controls. In the HRT group, women with an intact uterus were randomly allocated either to conjugated equine estrogens 0.625mg plus medroxyprogesterone acetate (CEE/MPA) or to 17β-estradiol 2mg plus norethisterone acetate 1mg (17βE2/NETA). Hysterectomized women received CEE 0.625mg only. The study period was 12 months. Women were subjected to mammography at baseline and at the end of the study period. Mammographic evaluation was performed according to the modified Wolfe criteria by two expert radiologists who were blinded with respect to the study groups.
RESULTS: The study groups did not differ between each other with respect to baseline demographic parameters and baseline mammographic classification. No increase in breast density was identified in any woman in the control group. On the contrary, 2 women (8%) in the CEE group showed an increase in breast density over 12 months of therapy. Accordingly, 4 women (11.8%) in the CEE/MPA and 11 women (31.4%) in the 17βE2/NETA group revealed an increase in breast density at the end of the study period. No woman in the HRT groups showed an involution of fibrogladural tissue while 7 women (25.9%) in the control group exhibited involution of breast lesions.

21. The effect of estrogen, continuous combined hormone replacement therapy and tibolone on mammography
Irene Lambrinoudaki, G. Christodoulakos, C. Panoulis, S. Dendrinos, A. Vourtsi,
C. Papadias, G. Creatsas
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaeion Hospital, Dionysos, Athens, Greece Maturitus,
44 Suppl. 2, S83-S166, 2003
Objectives: To evaluate the effect of estrogen, continuous combined hormone replacement therapy and tibolone on mammography. Methods: 153 postmenopausal women who had never received or were past users of hormone replacement therapy were studied prospectively. Women with an intact uterus were randomly allocated either to conjugated equine estrogens 0.625mg plus medroxyprogesterone acetate 5mg (CEE/MPA, n=34) or to 12β-estradiol 2mg plus norethisterone acetate 1mg (E2/NETA, n=35) or tibolone 2.5mg (n=32). Hysterectomized women received CEE 6.025mg (CEE, n=25). Women who either declined or did not qualify for treatment served as controls (n=27). Treatment was continuous and the study period lasted 12 months. Main outcome measures were the changes according to Wolfe classification between baseline and1 12-month mammograms. No increase in breast density was identified in any of the women in the control group. Two women (8%) in the CEE group showed an increase in breast density. Four women (11.8%) in the CEE/MPA and 11 women (31.4%) in the E2/NETA group revealed an increase in breast density. One woman in the tibolone group showed an increase in breast density (3.1%). Four women in the tibolone group (12.5%) and seven women in the control group (25.9%) exhibited involution of breast parenchyma. Concluding, our study suggests that hormone replacement therapy may suspend breast involution but does not increase breast density in the majority of patients. In the minority of patients who show a density increase, the magnitude of this increase varies according to the regimen employed. Tibolone, ot the other hand does not increase breast density and in some cases may promote involution of breast parenchyma.

22. Cost analysis of Computer-Aided Diagnosis in Medical Imaging. Medical Physics Vol. 35, Νumber 6, June 2008. Proceedings of the 1st Educational Means for Biomedical Technology and Medical Physics post-graduate. Farsaris M, Skopelitis M, Vourtsi A, and Kallergi M.
Purpose: To design implement, and evaluate a computer aided diagnosis (CADx) algorithm for the benign/malignant differentiation of breast calcifications clusters that uses features defined from both breast views recorded with other screen/film (SF) or full field digital mamography (FFDM). Methods: Two sets of data were tested in this work. An SF set of 101 pairs of images consisting of CC and MLO views of the same calcification cluster and an FFDM set of 50 pairs. Regions of interest, 512×512 pixels in size were selected on each view and centered on the calcification cluster of interest. Eight different experiments were conducted with the SFM set and one experiment is in progress with the FFDM data. The SFM experiments involved different methods of feature estimation from the two views, different sets of features, as well as a single-view based classification for comparison purposes. Results: On the single-view run the classifier achieved an AZ=0.889 with 88% sensitivity and 77% specificity at an operating point of 0.4; 12 features were selected as the most important. On the two-view dataset, the classifier trained only with the CC views achieved the highest AZ=0.968 and a sensitivity=98%; 9 features were the most important in the case. When the average value of features from the two views was used, classification achieved an AZ=0.958 with a sensitivity and specificity of 98% and 80 respectively. Combinations of features from the two views surpassed the average value classifier yielding an AZ=0.976 with 96% sensitivity and 82% specificity. Conclusions: The combination of two-view information is instrumental in enhancing CADx performance but faces several challenges particularly in setting criteria of the optimum selection of features from the two views. Our method was transferred from film to digital without major modifications. FFDM results will be reported in the meeting.

PUBLICATIONS IN GREEK JOURNALS

1. A case of ureteral diverticulum
P. Papadaki, Α. Vourtsi, Ν. Kounis, Ε. Mavroudi, D. Karakyklas, G.M. Zavras.
Iatrika Chronika, 1997;5: 269-270
A rare case of diverticulum of the ureter is presented. The aetiology, clinical and radiological picture of ureteral diverticulum is discussed, and the literature reviewed.

2. Radiological investigation of pelvic lipomatosis. A case presentation and literature review
P. Papadaki, Α. Vourtsi, Ν. Kounis, Ε. Mavroudi, D. Karakyklas, G.M. Zavras.
Iatrika Chronika, 1997;2:74-76
A rare case of pelvic lipomatosis is presented, with discussion of the clinical and radiological findings of the disease and its differential diagnosis.

3. Primary lymphoma of the colon. A case presentation and literature review
P. Papadaki, D. Karakyklas, Ν. Kounis, Ε. Mavroudi, Α. Vourtsi, A. Akatos-Tzitzimbasis, G.M. Zavras.
Iatrika Chronika, 1997;6:455-457
A case of primary lymphoma of the colon in an elderly patient is described. Primary lymphoma of the colon is an extremely rare condition, representing 0.05% of all the neoplastic processes of the colon and 0.1% of primary tumours of the rectum. However, it is increasingly observed now as it may appear in AIDS patients. Among the radiological methods for evaluation of the findings and staging of the disease we should mention barium enema as well as computed tomography and magnetic resonance imaging, which, in association with subsequent biopsy, have a significant role in the diagnosis of primary lymphoma.

4. Spontaneous retropharyngeal and subcutaneous emphysema of the neck as a complication of asthmatic attack
P. Papadaki, D. Karakyklas, Ν. Kounis, Ε. Mavroudi, Α. Vourtsi, G.M. Zavras.
Iatrika Chronika, 1997;3:196-198
We describe the case of a young, 18-year old patient, whose PA and lateral neck films showed free retropharyngeal air and subcutaneous emphysema as a complication of an asthmatic attack. These films were obtained after the chest radiograph raised the suspicion of subcutaneous emphysema in the area of the neck. We discuss the aetiology, pathogenesis, clinical findings and diagnostic criteria, particularly the radiological ones, and review the literature.

5. An unusual case of Wilson’s disease
Α. Vourtsi, Α. Koureas, L.Α. Moulopoulos, Α. Gouliamos, L. Vlachos
Elliniki Aktinologia, 1998;29:226-229
We present the case of a patient with Wilson’s disease with unusual clinical manifestation and course. A 29-year old man with a five year history of chronic active hepatitis was admitted to our hospital because of symptomatic deterioration, with evidence of liver dysfunction, ataxia and dysarthria. Laboratory testing for Wilson’s disease was negative. Magnetic resonance imaging of the upper abdomen showed findings of liver cirrhosis and portal hypertension. An unusually short T2 relaxation time of the liver was suggestive of the presence of paramagnetic substance in the liver parenchyma. Magnetic resonance imaging of the brain showed lesions in the basal ganglia, the thalamus and brainstem. Laboratory testing for Wilson’s disease was repeated, and it was positive. Early diagnosis of Wilson’s disease, before the establishment of permanent lesions in the liver and brain, is of the utmost importance for the effectiveness of therapy. This case highlights the potential role of magnetic resonance imaging in the diagnosis of Wilson’s disease when the clinical presentation is not specific.

6. Cystic enlargement of the sublingual gland (Plunging Ranula)
The contribution of ultrasound and computed tomography in the preoperative diagnosis

Α. Vourtsi, Ε. Pentea, Α. Kalovidouris, L. Moulopoulou, Α. Gouliamos
Elliniki Aktinologia, 1998;29:230-234
We describe a rare case of deep cystic enlargement of the sublingual gland (Plunging Ranula) in a 14-year old girl who developed progressive painful swelling of the left side of the neck.  We present the findings of ultrasonography and computed tomography and discuss their contribution in the preoperative diagnosis and differentiation of the disease from other similar pathologic processes.

7. Surgical gauzes in the abdomen: Imaging by computed tomography
Α. Kalovidouris, D. Kehagias, Α. Metafa, Α. Vourtsi, Α. Gouliamos, S. Pentea, Α. Moulopoulou, L. Vlachos
Elliniki Aktinologia, 1999; 30: 255-261
The aim of this work was to study the imaging findings in cases of surgical gauzes in the abdomen with computed tomography (CT). Eleven patients who had surgical gauzes left in the abdomen after a surgical procedure were examined with CT of the abdomen. We evaluated the appearance of the gauzes and its relation to the time interval after the operation, the presence of capsule, calcifications, and air bubbles. CT showed well circumscribed round or oval masses with variable morphology. In five patients there was a spongiform process, in three patients a mixed consistency lesion with hyperdense and hypodense elements, in two a hypodense inhomogenous lesion, and in one patient a lesion of cystic morphology. Mixed consistency and hypodense inhomogenous lesions with or without calcifications were gauzes that had remained there more than a year after the operation. In three cases calcifications were identified. CT is an excellent modality for the detection of surgical gauzes in the abdomen. If a space occupying abdominal process with the above characteristics is detected in patients with a history of abdominal operation, surgical gauze should be included in the differential diagnosis.

8. Neurosensory hearing loss: MRI and HRCT findings in a large patient series
Α. Vourtsi, Α. Papadopoulos, Ι. Xenellis, Κ. Adamopoulos, L. Vlachos
Elliniki Aktinologia, 1999;30:143-155
The aim of this study was to investigate the contribution of high resolution computed tomography and magnetic resonance in the detection of lesions in the inner ear and the auditory pathway in patients with neurosensory hearing loss. To this end, 126 patients (55 men and 71 women – mean age 47.5 years) with confirmed neurosensory hearing loss, underwent magnetic resonance imaging of the petrosal bones and as well as the whole brain. In all cases the paramagnetic substance Gd-DTPA was administered. Eighty-six of the patients (68%) also underwent petrosal bone scanning with high resolution computed tomography. Abnormal findings were detected in 35 patients (28%). Magnetic resonance after infusion of paramagnetic substance, in combination with high resolution computed tomography, disclosed abnormal findings in 10 patients with sudden bilateral hearing loss (28%). It is concluded that magnetic resonance has a high sensitivity for the detection of lesions of the membranous labyrinth and the central auditory pathway in patients with neurosensory hearing loss, while high resolution computed tomography is a complementary modality for the imaging of the bony labyrinth and the remaining bony structures of the petrosal bone. Undoubtedly, magnetic resonance offers important information for the solution of difficult clinical problems, which in the past, with older imaging methods, remained unresolved and were only detected during intraoperative pathologic examination or from the study of necropsy material.

9. Peripheral embolization (materials – indications – techniques)
Α. Hatziioannou, D. Mourikis, Α. Vourtsi, L. Vlachos
European Journal of Obstetrics & Genecology and Reproductive Biology 2000; 89: 63-67
This paper describes the general indications and contra-indications of embolization, the materials used, the technique, and finally the most common complications observed.

10. Modern views on the diagnostic approach to breast cancer
Α. Vourtsi, L. Vlachos
Archeia tis Ellinikis Iatrikis, For publication as Brief Review
Comparative studies of screening in Europe and America over the last decade showed significant reduction in breast cancer mortality ranging between 21% and 30% in women aged 40 to 69 years. On the basis of these results annual screening mammography in women over the age of 40 has been internationally established. On the contrary, ultrasonography has not proven useful in the screening of women for breast cancer, but is a useful adjunctive diagnostic modality for the differential diagnosis between cystic lesions and solid masses. Magnetic resonance imaging is nowadays only an investigative tool.

11. Unusual neoplastic diseases of the breast. Imaging findings
Α. Vourtsi
Published in the Topics of General Surgery, Α’ 1998
Lecture given in the course of postgraduate lessons of the Hellenic Surgical Society.
Imaging findings in unusual neoplastic breast diseases are described. These include inflammatory cancer, breast cancer during pregnancy, Paget’s disease, positive axillary lymph nodes in mammographically latent primary breast carcinoma, secondary breast cancer, sarcomas, and lymphoma.

12. Modern views of imaging screening for breast cancer
Α. Vourtsi
Lecture given in the course of postgraduate lessons of the Hellenic Surgical Society. Published in the Topics of General Surgery, Α’ 1999
The latest data on imaging screening for breast cancer is provided. Questions covered include how often should mammography be performed, at what age is it safe to stop screening mammography, and what are the effects of mammography-related radiation.

13. Newer imaging modalities in the diagnostic approach to breast diseases
Α. Vourtsi
Round table at the 4th Peloponnesian Medical Congress
Published in the journal Achaїki Iatriki,
Quarterly journal, Volume 5, 2000
The role of newer imaging examinations in the diagnostic approach to breast diseases is discussed.

14. Enlarged Vestibular Aqueduct Syndrome
S. Stathakopoulou, Α. Vourtsi, Α. Papakrivopoulos, Α. Papadopoulos,
Ι. Xenellis, L. Vlachos
Elliniki Aktinologia, To be published.
We describe the case of a 34-year old male patient with enlarged vestibular aqueduct syndrome. Imaging findings by magnetic resonance are pathognomonic for the diagnosis of this syndrome. This investigation should be performed as an adjunctive examination to HRCT, to improve the diagnostic and conservative or surgical therapeutic approach to patients with progressive neurosensory hearing loss.

15. Breast Cancer
Medical Analecta of the Hygeia Hospital Α. Vourtsi

16. Mammographic Imaging of Intraductal Breast Carcinoma
Α. Vourtsi
Medical Analecta of the Hygeia Hospital, Issue 16, April-June 2002

17. Mammography in the early diagnosis of breast cancer: Pro and Con
Α. Vourtsi
Medical Analecta of the Hygeia Hospital, Issue 21, July-September 2003

18. What are the risk factors for developing breast cancer?
Α. Vourtsi
Nursing Forum of the Hygeia Hospital, Issue 4, 2003

PARTICIPATION IN GREEK CONFERENCES

1. A brief historical review of large bowel imaging by conventional radiology.
P. Papadakis, Μ. Zyga, Α. Vourtsi, Α. Balanika, Μ. Papadimitriou, Δ. Karakyklas,
Ν. Kalantzis, Ν. Hatziioannou
14th  Panhellenic Congress of Gastroenterology, Athens, 16-20 November 1994
The aim of this work is a historical review of the various stages in the radiological diagnosis of large bowel pathology by conventional radiological techniques from the discovery of X-rays (Roentgen 1985) to the present day. The first radiological imaging of the colon was announced by Walse, who saw the colon on the abdominal film of a patient who had received bismuth for therapeutic purpose. The first bismuth enema was performed by Schule in 1904. Barium was first used as a contrast material for the digestive tract by Cannon in 1896 on an experimental basis. Barium sulphate by oral administration for digestive tract examinations was applied by Karl Bachem and Hans Gunther in 1910. In 1914 bismuth was permanently replaced by barium sulphate. Iaurell and Odquist in Sweden in 1921 and A.W. Fischer in 1923 used the technique of double contrast of the large bowel, which was improved in 1930 by Kirklin and Weber in the Mayo Clinic. Further improvements were made by S. Welin in 1963 (Malmo, Sweden), aiming at better images and the delineation of polyps. Constant effort to improve the imaging techniques of the colon, development of contrast materials and advanced technology have nowadays made examination of the large bowel more diagnostic and better tolerated by the patient, with parallel reduction in radiation dose.

2. Enteroclysis in Crohn’s disease
Α. Vourtsi, Α. Kalli, Μ. Zyga, G. Halaris, Κ. Tasioulas, Ι. Kaniklis, Α. Dervidou,
Ν. Hatziioannou
14th  Panhellenic Congress of Gastroenterology, Athens, 16-20 November 1994
The aim of the present study was to present our cases of  Crohn’s disease studied by the enteroclysis technique. We studied eight patients with Crohn’s disease (5 men, 3 women), aged between 18 and 75 years (mean 41 years). For the purpose of the examination meticulous clearance of the enteric tract was achieved by cellulose-free diet for the last three days, fluid-only intake and avoidance of laxatives. The duodenum was catheterized with Bilbao-Dotte catheter, through which 400 mls of 25% W/V barium sulphate suspension were infused beyond the ligament of Treitz, followed by 1200 mls of water to achieve double contrast images. In three patients early signs of Crohn’s disease were shown such as spasm of the affected bowel loop, aphthous ulcers, and thickening of the folds. In one patient profound ulcers were shown, which on lateral radiological view had a collar button appearance. In the remaining four patients there was a cobblestone appearance as well as strictures with pre-strictural distention of bowel loops. The diagnostic accuracy of enteroclysis makes it the investigation of choice for both early-stage diagnosis and follow-up of Crohn’s disease.

3. Is magnetic resonance imaging necessary in patients with neurosensory hearing loss?
Α. Vourtsi, Α. Papadopoulos, Κ. Papafrangos, Ι. Xenellis, Κ. Kanellis, L. Vlachos,
G. Adamopoulos
8th Panhellenic Congress of Otorhinolaryngology and Head & Neck Surgery, Limassol, Cyprus, 2-5 November 1995
The role of magnetic imaging in the examination of the inner auditory canal and pontocerebellar angle in patients with neurosensory hearing loss has been adequately studied. The same is not true for cases where neurosensory hearing loss is the result of other, les known causative factors which damage both the peripheral and the central auditory pathway. In this work we analyse the results of magnetic resonance imaging in 126 patients with neurosensory hearing loss studied in the ENT department and the radiology laboratory of the University of Athens.

4. The importance of magnetic resonance imaging in lesion localisation in patients with sudden neurosensory hearing loss
Α. Papadopoulos, Α. Vourtsi, Ι. Xenellis, Κ. Papafrangos, Κ. Kanellis, G. Adamopoulos, L. Vlachos
8th Panhellenic Congress of Otorhinolaryngology and Head & Neck Surgery, Limassol, Cyprus, 2-5 November 1995
Sudden neurosensory hearing loss is known to be a common clinical manifestation of the involvement of the auditory system by numerous aetiological factors. Therefore it is obvious that appropriate management requires the correct identification of the damaging factor in each case. We believe that magnetic resonance is the most reliable investigation for this purpose. Between January 1992 and December 1994, 67 patients with sudden neurosensory hearing loss of less than one month’s duration were managed in the ENT Department of the University of Athens. All the patients, apart from an extensive biochemical and immunobiological workup, were submitted to imaging of the cranial cavity by computed tomography and magnetic resonance. In 8 patients the aetiopathological factor responsible for the sudden neurosensory hearing loss was only revealed by magnetic resonance. This paper reviews these cases and examines the reliability of magnetic resonance imaging in the localization of the lesion.

5. Intravaginal ultrasonography in the diagnosis of ectopic pregnancy
Α. Vourtsi, Μ. Tzalonikou, Ε. Kapsalaki, Α. Antoniou
5th Interuniversity Radiological Conference, Ioannina, 3-5 November 1995
The timely diagnosis of ectopic pregnancy at 3-4 weeks poses specific problems in its clinical, biochemical and also ultrasonographic approach. We present the ultrasonographic findings of both suprapubic and intravaginal ultrasonographic scanning in 12 cases of ectopic pregnancy, and correlate these with the clinical and biochemical findings.

6. Presentation of a case of extensive transitional epithelium carcinoma of the urinary tract
Μ. Tzalonikou, Ε. Kapsalaki, Α. Vourtsi, Α. Pafiti, Α. Antoniou
5th Interuniversity Radiological Conference, Ioannina, 3-5 November 1995

7. Intracranial aneurysms in polycystic kidney disease. Their detection with magnetic resonance angiography
Α. Vourtsi, Α. Papadopoulos, Γ. Katsioudas, S. Voudiklari, S. Golfinopoulos, L. Vlachos
10th Panhellenic Congress of Radiology, Athens, 27-30 March 1996
Intracranial aneurysms are a typical manifestation of adult-type polycystic kidney disease. The aim of the present study was to evaluate the prevalence of intracranial aneurysms in patients with polycystic kidneys by magnetic resonance angiography. The study included 29 patients suffering from polycystic kidney disease. All 29 patients were scanned with SE PD and T2-W sequences for imaging of the brain. Subsequently magnetic resonance angiography was performed with 2D-TDF and 3D-TDF techniques. Intracranial aneurysms were detected in 5 of the 29 patients (17% of the study group, compared with 1% observed after imaging study [by arteriography] of a sample of the general population). Magnetic resonance angiography is a sensitive and non-invasive method for the detection of intracranial aneurysms, and can be used as a screening method in patients with increased probability of intracranial aneurysms such as polycystic kidney patients.

8. Polypoid cholesterolosis of the gallbladder. Ten-year experience
Μ. Tzalonikou, Α. Vourtsi, Α. Antoniou, Α. Pafiti, G. Polymeneas, Ε. Vazoura
10th Panhellenic Congress of Radiology, Athens, 27-30 March 1996
Polypoid colesterolosis, either single in the form of cholesterol polyps, or multiple as papillomatous projections of the wall, is a long known pathological finding, and is particularly common in gallbladder ultrasonography. Between 1982 and 1994, in 70,000 upper abdomen ultrasonograms performed, papillomatous projections of the gallbladder wall smaller than 1 cm (range: 3-7 mm) were diagnosed in 3500 patients. Of those, 81 patients have been followed up at regular intervals until today, 144 patients were operated, and the remaining did not return. In 25 patients operated after 3-8 years from initial presentation gallstones were also found. Apart from cholesterol polyps, true adenomas, and epithelial hyperplasia, there was no development of cancer.

9. Presentation of a case of metastatic carcinoma in the lateral abdominal wall from a small cell carcinoma of the lung
Μ. Tzalonikou, Α. Vourtsi, D. Voros, Ε. Kairi, Ε. Kapsalaki, Α. Antoniou
10th Panhellenic Congress of Radiology, Athens, 27-30 March 1996
We present the radiological and pathological findings in a case of Metastatic carcinoma in the left lateral abdominal wall after small cell carcinoma of the lung. The patient had undergone chemotherapy for the lung cancer, and developed metastases in two stages, first in the right ovary, when total hysterectomy with removal of appendages was performed, and then in the left lateral abdominal wall, in the form of two irregular tumour masses.

10. Ectopic pregnancy. Diagnostic approach with intravaginal colour Doppler echotomography
Α. Vourtsi, Μ. Tzalonikou, Th. Stefanopoulos, Ε. Kapetanakis, Ε. Vazoura, Α. Antoniou
10th Panhellenic Congress of Radiology, Athens, 27-30 March 1996
The aim of this study was to assess the value of intravaginal colour Doppler echotomography in the early diagnosis of ectopic pregnancy and its differential diagnosis from other pathology. Between January 1993 and November 1995, we studied with intravaginal ultrasonography 240 pregnancies where conception was achieved by insemination or in vitro fertilisation. As these pregnancies belong in a high risk group for ectopic pregnancy, we used for diagnosis the technique of intravaginal colour Doppler echotomography 3 or 4 weeks after implantation and a positive pregnancy test (βb-HCG). For the study we used the ACUSON 128 XP/4 ultrasound scanner with an EC7 colour Doppler probe and a soundwave frequency of 7 Mhz. Biochemical screening (β-chorionic gonadotrophin and progesterone) was performed in all cases. Thirty four (34) ectopic pregnancies with or without heartbeat were diagnosed with intravaginal colour Doppler ultrasonogram, and the diagnosis was confirmed by laparoscopic surgery in all 34 cases. Intravaginal colour Doppler ultrasonography is today the most reliable method for the diagnosis of early ectopic pregnancy via the detection by Doppler technique of the foetal heartbeat and perfusion of the chorionic ring, and also for the differential diagnosis from other similar processes.

11. Malignant mesothelioma of the peritoneum
Α. Vourtsi, Μ. Tzalonikou, Α. Pafiti, Th. Stefanopoulos, Ε. Kapsalaki, Α. Antoniou
10th Panhellenic Congress of Radiology, Athens, 27-30 March 1996
We present a case of malignant mesothelioma of the peritoneum in a 65 year old woman. We examine the findings of imaging studies (ultrasound, computed tomography before and after administration of contrast material), which showed a space-occupying lesion 4 cm in diameter in the right lateral abdominal area. The lesion was surgically excised, and histological examination proved that this was a malignant mesothelioma of the peritoneum.

12. The contribution of colour Doppler echotomography in the detection of venous thromboses in patients with tibial fractures
L.A. Livieratos, Α. Vourtsi, Α. Petinelli, Κ. Haritidis, S. Pantou, L. Athanasopoulou, Α. Psyropoulos, G.M. Zavras
6th Interuniversity Radiological Conference, Larisa, 1-3 November 1996

13. Assessment of the frequency of superficial femoral vein thrombosis in the presence of thrombosis of the common femoral and popliteal vein with colour Doppler echotomography
L.A. Livieratos, Ε. Mavroudi, Μ. Suelem, Δ. Karakyklas, Α. Vourtsi, P.Α. Livieratos, Ε. Zacharaki, G.M. Zavras
6th Interuniversity Radiological Conference, Larisa, 1-3 November 1996

14. The effect of the position and shape of the carotid bulb on the determination of shear stress with colour Doppler echotomography
L.A. Livieratos, Α. Vourtsi, G. Theodorakopoulos, P. Papadopoulou, G. Spanomichos,
G. Katerina, S. Kramanos, G.M. Zavras
6th Interuniversity Radiological Conference, Larisa, 1-3 November 1996

15. Intracranial aneurysms: comparative study of conventional magnetic resonance imaging and magnetic angiography
Α. Papadopoulos, Μ. Douskou, Β. Vandali, P. Papagiannopoulos, Ε. Georgiadis,
Ch. Triantafyllou, Α. Vourtsi, Ch. Drosos
7th Interuniversity Radiological Conference, Heraklion, Crete, 24-26 October 1997
Magnetic resonance has been established as the best non-invasive method in the investigation of intracranial aneurysms.  The aim of this study was to evaluate the sensitivity and the additional information provided by magnetic resonance angiography in comparison with conventional SE and turbo-SE techniques in the investigation of intracranial aneurysms. We studied 10 patients with 11 intracranial aneurysms. Comparative assessment was made between (a) transverse and coronal T2W images with SE or turbo-SE techniques, and (b) magnetic resonance imaging with 3D-TOF technique (before and after image processing with MIP technique). Conventional SE technique revealed all 11 aneurysms, but in two cases confirmation by angiographic imaging was necessary. Magnetic resonance angiography after processing with MIP technique revealed 7/11 aneurysms. The four aneurysms that were not revealed were thrombosed, and two of them were giant aneurysms. The repeat study of the source images disclosed additional aneurysms. Magnetic resonance angiography, especially after image processing with MIP technique, is inferior to conventional magnetic resonance imaging in the detection of intracranial aneurysms as it cannot image thrombosed aneurysms. It provides supplemental information for their confirmation and more precise mapping. Comparative study of both techniques is necessary in the investigation of patients with suspected intracranial aneurysm.

16. The diagnostic value of intravaginal ultrasonic hysterosalpingography in the investigation of patients with transient infertility
Α. Vourtsi, Th. Stefanopoulos, Α. Antoniou, Ε. Kapetanakis, L. Vlachos
Panhellenic Radiological Congress, Thessaloniki, 23-27 September 1998
The aim of this study was to investigate the diagnostic value of intravaginal ultrasonic hysterosalpingography in the investigation of patients with transient infertility. Intravaginal ultrasonic hysterosalpingography was performed in 55 women (age range: 32-50 years) with inability to conceive and abnormal echogenicity of the endometrium after intravaginal echotomography. In all cases 10-20ml of sterile normal saline was instilled in the uterine cavity with a H/S catheter under direct ultrasound control. The findings were confirmed by hysteroscopy. In 30 women endometrial polyps were detected. In 15 women fibroids were found. There were no complications. From our study we conclude that intravaginal ultrasonic hysterosalpingography is a simple and easy method with high sensitivity for the preoperative diagnosis of pathologic processes of the uterine cavity. This should lead to better management of transiently infertile women and obviate futile attempts at artificial fertilization.

17. The contribution of echotomography in the study of inflammatory breast lesions
Α. Kalovidouris, Α. Vourtsi, S. Pentea, Α. Antoniadou, Ε. Giamarellou
8th Interuniversity Radiological Conference
Over the last three years 141 patients with a clinical diagnosis of breast inflammation were submitted to echotomographic investigation. The aim of echotomography was to confirm the clinical diagnosis, to assess the kind of inflammation (inflammatory abscess etc) and to define its extent during initial examination. All the patients underwent 1 to 4 additional examinations during therapy (range: 10 days to 8 months) to monitor the disease and evaluate response to treatment. On initial examination, 65 patients had an appearance of phlegmon, 53 patients had an atypical picture in the form of circumscribed inflammatory change, mildly hyper- or hypo-echoic, which resembled a benign non-inflammatory process. All the atypical inflammatory lesions subsided with treatment. We conclude that echotomographic investigation of breast inflammation is indicated for the evaluation of the type of inflammation, its extent, and to assess the response to treatment.  Lesions and Hormone Therapy.