Iranian Journal of Radiology
Volume:14 Issue: 3, Jul 2017

Percutaneous treatment of the hydatid cyst has been well documented that morbidity and mortality rates, hospitalization time, and recurrence rate associated with percutaneous treatment are significantly less than those with surgery.
To research the success rate of treatment of hydatid cyst by modified percutaneous treatment using a trocar technique.
Patients and Patients who had intra-abdominal hydatid cyst were treated by a modified percutaneous technique were included the study. This study included patients who were treated between June- 2003 and April-2015. We excluded patients who either had biliary fistula during the intervention or did not participate in the follow-up sessions. Medical treatment with albendazole was performed before and after the procedure. Patients were followed up at 3, 9, 12, 24, 36, and 48 months after the procedure.
Out of a total 83 patients, 10 patients had biliary fistula, so they underwent surgical treatment. 13 patients did not come to the controls. As a result, 60 patients who had 72 intra-abdominal hydatid cysts underwent percutaneous ablation treatment. 48 patients who had 59 hydatid cysts were cured after the first intervention. After initial treatment, the success rate was 81, 9%, and after the secondary intervention, the success rate was 94, 4%. The average diameter of cysts that were cured in a single session was 6, 9 ± 2, 2 cm; the average diameter of cysts that were removed during the secondary intervention and surgical treatment was 10, 2 ± 3, 4 cm.
Whatever the hydatid cyst size, if a drainage catheter is used for initial puncture using the trocar technique, it will be safer and more comfortable for patients compared with the PAIR or catheterization technique.

Spinal metastases are the most common type of metastatic bone tumors. Various therapeutic approaches have been used to treat spinal metastases, but traditional treatments are often limited and ineffective. Minimally invasive interventional technology has been successfully performed in the clinical setting.
This study is designed to evaluate the curative effect of spinal metastases treated by percutaneous vertebroplasty (PVP) and transcatheter arterial infusion/chemoembolization (TAI/TACE).
Patients and A prospective study was performed for 18 consecutive patients with spinal metastases justified by imaging findings and pathology, including 12 men and 6 women, with the mean age of 64.56 ± 11.07 years (range, 50 - 90 years). All patients first underwent PVP and then TAI/TACE. The degree of pain relief was assessed with visual analogue scale (VAS) and WHO standard. The rating of the activity of daily life (ADL) was utilized to evaluate the quality of life. The activities of daily life (ADL) were evaluated with modified Barthel index system. The size of tumor and further bone invasion were evaluated three months after surgery.
We achieved a 100% success rate of all interventional operations. The effective rates of pain relief were respectively 94%, 94%, 89%, and 78% for one-day post-op, one-week post-op, one-month post-op, and three-months post-op. VAS for back pain was 7.7 ± 0.8, 5.3 ± 0.6, 3.4 ± 0.8, 2.0 ± 0.6, and 1.5 ± 0.6 for pre-operative, one-day post-op, one-week post-op, one-month post-op, and three-months post-op, respectively. The improvement of VAS was respectively 2.3 ± 0.6, 4.3 ± 0.9, 1.4 ± 0.8, and 1.8 ± 0.7. Preoperative and postoperative 3 months Barthel index was 45.3 ± 12.5 and 85.6 ± 14.2, respectively. There were significant difference in pain relief and the ability of daily life between pre-operation and post-operation time points (P PVP combined with TAI/TACE is a safe and effective technique for treatment of spinal metastases. PVP is effective for pain relief but has a limited antitumor effect, while TACE kills tumors more thoroughly compared to PVP. The combination of two therapies can make up for the shortcomings of each other and obtain definite effect, which markedly improves the patients’ living quality.

Catheter hemodialysis is the last choice for end stage kidney disease patients. Unfortunately, long-term catheterization can lead to problems that make re-catheterization challenging. Sometimes the physician has to try catheterization through several veins and stays close to the patient during the procedure that may lead to a high radiation dose exposure to the radiologist, so that some radiologists refuse to admit such patients.
The objective of this study was an assessment of the radiation dose of radiologists and patients during the placement of double lumen catheter in difficult cases.
Patients and The thermoluminescent dosimeter (TLD) was used to measure the delivered radiation dose to physicians. During the procedure, a package of dosimeter was placed on the thyroid shield and another on the chest, under the apron in order to calculate the occupational effective dose. Moreover, patient information and parameters of the procedure were recorded in order to estimate the patient dose during the procedure.
The mean effective dose provided by TLDs, dose/procedure, and the annual dose of physicians resulted from this procedure were 30.38 µSv, 0.02 µSv/procedure, and 350.20 µSv/y, respectively. The mean dose area product, dose, and calculated peak skin dose obtained in this study were 151.44 cGy.cm2, 851.71 mGy, and 384.97 mGy, respectively.
The mean effective dose of physician per case is about 0.02 μSv/procedure which is much less than the radiation dose per other procedures. Briefly, it can conclude that double lumen replacement does not deliver an unacceptable radiation dose to the physician and even the radiation dose resulted from these cases are much less than the other procedures.

Renal artery stenosis can cause renovascular hypertension manifesting clinically as high blood pressure.
In this study, we determined the efficiency of non-contrast magnetic resonance angiography (NC-MRA) using the inflow inversion recovery (inhance) method in the evaluation of renal arteries of hypertensive patients.
Patients and Three-dimensional (3D) contrast-enhanced magnetic resonance angiography (CE-MRA) and NC-MRA were used to prospectively evaluate 66 patients diagnosed with hypertension. 3D CE-MRA and digital substractional angiography served as the gold standards. Image quality, number of main/accessory renal arteries, and main renal artery diameters were assessed. Statistical analyses were based on paired-t tests and intra-class correlation coefficients.
Of the 126 main renal and 12 accessory renal arteries reviewed in this study, NC-MRA overall image quality was good or excellent in more than 89.5%. An image quality of 94% was recorded for both left and right sides with CE-MRA. The differences between the 3D CE-MRA and NC-MRA readings for the renal artery ostium and proximal, medial, and distal segment diameters were not significant (P > 0.05). Inter-reader agreement regarding all segments was excellent. 3D CE-MRA was superior to NC-MRA in assessing accessory renal arteries (detection ratio using NC-MRA: 7/12, 58%).
NC-MRA using the inhance method to image the anatomy of the renal artery provides an alternative to CE-MRA in patients with hypertension.

In the intervening years, a few randomized clinical trials have confirmed that foam sclerotherapy is effective in managing great vein incompetence. However, no details have been published in its efficacy in comparison with conventional methods such as stab avulsion in the treatment of varicosis in small veins.
This randomized clinical trial was conducted to compare results and outcomes of the ultrasonography-guided foam sclerotherapy and conventional stab avulsion ambulatory phlebectomy in the treatment of varicosis in small veins of the leg.
Patients and In a randomized single-blinded clinical trial, patients with varicosis in the small veins of the leg were randomly assigned for treatment with ultrasonography-guided foam sclerotherapy (n = 45) or with ambulatory phlebectomy (n = 45). Follow-up visits were done in 1 week, 1 and 6 months after operation and all patients were assessed regarding postoperative pain, need for analgesics, time to return to work, and level of satisfaction.
Postoperative pain was significantly lower in foam sclerotherapy group by VAS (P = 0.003). There was a significant difference in the morbidity rate between the two techniques (13.3%. in foam sclerotherapy, 37.8% in ambulatory phlebectomy, P = 0.008). The main predictors of the pain incidence included ambulatory phlebectomy, female gender, and advanced age. Satisfaction was significantly higher in foam sclerotherapy group (P = 0.024). Also, this group had shorter time to return to work (P Foam sclerotherapy is more preferred to ambulatory phlebectomy for treating varicosis in small veins of the leg because of its lower morbidity, less pain, more satisfaction, and shorter time to return to work.

The high pitch, dual source computed tomography (CT) provides motion-free aortic imaging.
To evaluate the image quality of coronary artery using dual-source CT aortography without electrocardiogram (ECG) synchronization.
Patients and One hundred fifty patients (87 men; mean age; 63.7 ± 13.0 years, mean heart rate; 64.7 ± 6.6 beats/min) with suspected or known aortic disease underwent non-ECG gated, high-pitch, dual-source CT aortography. No beta blocker or nitroglycerin was administered for the patients. The image quality of each coronary artery segment and its ostium was graded on a three-point scale (excellent, moderate, and non-diagnostic image quality).
Most patients (88.7%) showed diagnostic image quality in the ostia of the left main and right coronary artery. Among 1894 coronary arterial segments, 870 (45.9%) segments were rated as excellent image quality, 507 segments (26.8%) were rated as moderate image quality, and 517 segments (27.3%) were rated as non-diagnostic image quality. In the per-vessel analysis, non-diagnostic image qualities were often found in right coronary artery (44.0%) and left circumflex artery distribution (36.0%). In contrast, non-diagnostic image qualities were less frequently found in left main (0.67%) and left anterior descending distributions (9.9%).
Non-ECG gated, high-pitch, dual-source CT can be useful to evaluate the coronary ostial involvement in patients with ascending aortic dissection. The left main and left anterior descending coronary arteries exhibit relatively good diagnostic image qualities compared with left circumflex and right coronary arteries.

Fluoroscopy guided imaging, which is going to be more routine these days, requires a long time of fluoroscopic observing that could increase the radiation dose of the physician and other staff who have to stay near the patient during the procedure. In our department, one of the senior interventionists observed hair loss in his lower limb.
The objective of this study was to measure the radiation dose of the physician’s leg during common procedures in order to find out that whether the radiation dose exceeds the threshold of deterministic effects of radiation.
Patients and Thermoluminescent-dosimeters (TLD-100) set on the leg part of the anthropomorphic whole body phantom PBU-50 was used in order to measure the radiation dose in two centers where our interventionist worked. Meanwhile, the duration of exposure in important procedures was observed and recorded in center 1 for 2 months. During this period, data including age, height, and weight of the patients, and radiation exposure time, dose (mGy) and dose area product (dap) (µGy.cm2) were recorded.
The result of TLD dosimetry showed that the mean effective dose in center 1 and 2 was 0.20 and 0.86 mSv, and also the mean-dose (mSv)/min) in these centers was 0.02 ± 0.00 and 0.20 ± 0.015 mSv/min, respectively.
The effective annual dose of interventionists who work in center 1 and 2 was 143.08 and 1226.78 mSv, respectively. The high radiation dose delivered to the leg of physicians in center 2 could be an important cause of radiation dermatitis occurred on the leg of our interventionist. Patient dose during most of the procedures was less than the threshold dose for occurring erythema. However, unfortunately in transjugular intrahepatic portosystemic shunt (TIPS) procedure, which is a time-consuming procedure, the patient radiation dose exceeds the threshold. It would be useful if a plan was designed to reduce the dose of patients and even physicians.

Radiochromic gel is recently introduced as a three dimensional dosimeter that exhibits color changes by being exposed to ionizing radiation. Therefore, the read-out system of this dosimeter should be based on radiochromic response.
The aim of this study was to introduce a novel design of machine called optical computed tomography (OCT) and acquire the three dimensional dose distribution of ionizing radiation by using the Radon transform image reconstruction technique.
By assembling red light-emitting diode as a light source, two lenses, charge-coupled device (CCD) camera, step motor, matching liquid, radiochromic gel, and a base frame, a novel design of OCT was manufactured. Then a sample of radiochromic gel was irradiated and scanned by novel OCT. The acquired images were then reconstructed by using the Radon transform algorithm and consequently the dose distribution was mapped. Finally the results of this device were verified by an ion chamber.
By setting up the required accessories, a new design of OCT was constructed. The verification test showed that the results of novel OCT could be reliable by almost ± 3% deviations.
The results of this study confirmed that not only the Radon transform algorithm could be used for reconstructing computed tomography (CT) images, but also this technique could be applied for imaging the dose map of ionizing radiation obtained by OCT. Moreover, novel OCT- radiochromic gel could be considered as a proper system for acquiring three dimensional dose distribution of ionizing radiation.

Endovascular embolization is one of the main modalities in the treatment of brain arteriovenous malformations (AVMs). Onyx (ethylene-vinyl alcohol copolymer) is a new embolic agent with some advantages of slow injection and better control of penetration.
To report our experience in the embolization of brain AVMs with Onyx.
Patients and From August 2012 to October 2014, 53 consecutive patients harboring brain AVM were treated with Onyx as the sole embolic agent during 85 procedures. There were 27 males and 26 females with a mean age of 27.2 years (range, 8 - 65 years).
The presenting symptom was headache in 25 (47%), neurological deficit in 18 (35%), and seizure in ten (18%) patients. According to the Spetzler-Martin grading scale, three of the AVMs were ranked as grades I, 11 as grade II, 22 as grade III, 14 as grade IV, and three as grade V. An average of 1.8 feeding pedicles were embolized in each case, whereas a mean of 2.23-mL Onyx was used per patient. Initial complete obliteration at the end of all embolization procedures was achieved in 11 patients (20.08%). The rate of complete embolization at 6-month follow-up was 15%. After completion of embolization, the neurologic status was unchanged or improved in 46 (87%) patients. We observed treatment-related neurologic deficit in seven (13%) patients, of whom five were permanent (10%). There was no procedure-related death.
Our experience with Onyx used for embolizing AVMs was satisfactory. Controlled injections that protect the draining veins make the therapy safe even in complex AVMs.

Prostate cancer continues to be diagnosed with increasing frequency. Multiparametric magnetic resonance imaging (MP-MRI) has a favorable correlation with prostatectomy histopathology findings. These advanced functional imaging techniques may help increase the sensitivity of prostate cancer detection and the accuracy of predicting the Gleason score (GS), which is a measure of cancer aggressiveness.
The purpose of this study was to determine associations between MP-MRI parameter and whole-mount pathological finding as reference standard.
Patients and Twenty-four consecutive prostate cancer patients who underwent an MRI exam followed by radical prostatectomy were incorporated in this study. The average time between MRI and prostatectomy was 40 days (7 - 100 days). All patients had biopsy proven adenocarcinoma of the prostate and the mean GS was 6.7 (median, 7; range 6 - 9).
The mean age was 59 ± 7 years. The mean serum prostate specific antigen (PSA) was 7.81 ± 5.73 ng/mL. The GS ranged from 6 to 9 and most patients (79%) had a GS of 7. MRI data were correlated to biopsy results. Pearson correlation analysis revealed a significant negative correlation between GS and apparent diffusion coefficient (ADC) measurements (r = -0.926, P = 0. 01), and a strong positive correlation between Gleason scores and MRS measurements (r = 0.965, P = 0.01). No significant correlation was observed between any of the dynamic contrast enhanced MRI (DCE-MRI) parameters and GS.
Combining anatomical and functional MRI significantly improves prostate cancer localization. It is a useful tool in the diagnosis and management of prostate cancer as well as a valid tool for assessing men on active surveillance. However, it should not be seen as a replacement for tissue biopsy.

Myocardial infarction remains a leading cause of morbidity and mortality among cardiac disease. Cardiac wall thickening in patients with myocardial infarction is less than healthy individuals. Accurate measurement of cardiac wall fractional thickening and path-length of myocardium points in healthy data and patients with myocardial infarction can help physicians in diagnosing the affected area.
Patients and Epi/Endocardium of all slices in end-diastole frame were segmented, then more than 150 points in each slice were selected to track by weighted normalized mutual information algorithm over all frames. Weighted normalized mutual information was computed between two three-dimensional masks sized 3× 3 × 3, pixel that were located in end-diastole and subsequent frames centroid of the selected points. Finally, by computing the distance between endocardium and epicardium in each slice over all frames, cardiac wall thickness and fractional thickening was measured. Moreover, the path-length of each data point during cardiac period was calculated and sketched in bulls-eye format. Evaluation of the method was done by ten healthy and twenty patients with myocardial infarction.
Cardiac wall kinesis was evaluated by normalized path length, which was presented in standard 17-segment bull’s-eye format. Wall thickness and fractional wall thickening for all slices over all frames were extracted in order to determine the infarct region. Infarct regions had minimal fractional thickening and normalized path length. All evaluations demonstrated hypo-kinesis in the damaged region.
Evaluation of obtained results showed significant difference between local parameters of healthy and infarcted myocardium. In all patients, the process was able to precisely determine the affected region that was all well matched with clinical evidence.

Background/ The purpose of this study was to assess the efficacy of pain control at a single center in a population of patients with osteoporotic fractures or vertebral metastasis after vertebroplasty (VP).
Patients and We retrospectively evaluated 163 patients who underwent VP at our institution between January 2008 and March 2016. Pain was measured with the visual analogue scale (VAS). The impact of pain on the quality of life (QoL) of the patients was estimated using the modified Roland–Morris questionnaire (RMQ). The VAS and RMQ values were calculated before the VP procedure and at one month and 6 months after the treatment.
VAS and RMQ mean scores were 7.8, 3.9 and 3.5, and 20.7, 11.5 and 9.6 before the procedure and at the 1 month and 6 months follow-up, respectively, which showed significant improvement (P This retrospective study assessed the efficacy of VP treatment for vertebral fractures due to osteoporosis or tumor infiltration and showed significant pain relief and improved QoL.

In recent years, a few studies have addressed the effect of chronic heroin use on brain structure with respect to volume and shape; however, the literature in this field is sparse and further studies are necessary to generate robust replications.
In this study, we intended to assess gray matter density (GMD) differences between successfully abstinent heroin dependents and healthy subjects. Indirect evidences for the causal role of drug use in the GMD differences are also targeted here by testing the hypothesis on the correlation between GMD differences and duration of drug use.
Patients and Using structural magnetic resonance imaging (MRI) and voxel-based morphology (VBM) technique, changes in gray matter volume and density were evaluated in 18 abstinent heroin dependents and 20 age-, education- and gender-matched healthy subjects. Heroin dependents were all male, and at least 3 months successfully abstinent (mean abstinence duration = 9.2 ± 5.2 months).
Decreased GMD in the right anterior cingulate cortex and bilateral putamen were found in abstinent heroin dependents in comparison to controls, corrected for multiple comparisons (P Specific structural changes were noticeable in prefrontal and striatal areas in the heroin dependents even after a period of successful abstinence. Our results on the interaction between duration of drug use and some of these structural changes provides preliminary ideas for reciprocal cause and effect roles for brain structural changes and heroin abuse. These findings might also imply that brain structures are unable to return to normal state and cannot recover spontaneously even after months of abstinence. This evidence reminds us of the importance of neurorehabilitation interventions after termination of drug use.

Fluorine-18 fluorodeoxyglucose (F-18 FDG)-positron emission tomography/computed tomography (PET/CT) is widely used in most malignancy workups, including detection, differential diagnosis, staging and/or restaging, therapeutic decision-making, follow-up, and prognosis.
The aim of this study was to evaluate the usefulness of F-18 FDG-PET/CT for predicting breast cancer molecular subtypes.
Patients and Sixty-six patients with pathologically proven invasive breast carcinoma (IBC) underwent F-18 FDG-PET/CT imaging for tumor staging. The maximum standardized uptake value (tumor SUVmax) of the IBC and mean SUVs of the liver and spleen (liver and spleen SUVmean) were measured. Molecular subtype was determined according to genomic analysis. The tumor SUVmax, tumor-to-liver SUV ratio, and tumor-to-spleen SUV ratio were correlated with molecular subtype data.
Logistic analysis demonstrated that only the tumor-to-liver SUV ratio was a significant parameter for human epidermal growth factor type 2 (HER2)-positive subtype identification (P = 0.0049). The sensitivity, specificity, and area under the receiver-operating-characteristic curve (AUC) of this parameter for HER2-positive subtype detection were 83%, 79%, and 0.87, respectively.
The tumor-to-liver SUV ratio appears to be useful for HER2-positive subtype identification, thus indicating the potential use of F-18 FDG-PET/CT as an imaging biomarker that could facilitate the clinical management of patients with breast cancer.

The pulmonary artery obstruction index (PAOI), which is evaluated by the CT pulmonary angiography, offers an objective method to measure the severity of pulmonary arteries obstruction.
We decided to investigate the correlation between the PAOI determined by CT pulmonary angiography, as an index to determine the severity of pulmonary embolism (PE), with two clinical models used for predicting the probability of acute PE, namely the Wells criteria and the simplified revised Geneva score.
Patients and Sixty-four consecutive patients with definite diagnosis of acute PE based on CT pulmonary angiography were enrolled. The Wells score as well as simplified revised Geneva score were calculated retrospectively using the medical records. Then, the PAOI was determined by CT pulmonary angiography. By applying the Pearson’s correlation coefficient, the relationships were investigated.
The Wells score had a weak correlation with the PAOI (r = 0.29; P = 0.01). The simplified revised Geneva score did not have significant correlation with the PAOI (r = 0.1; P = 0.2). Furthermore, patients with active cancer had significantly higher CT indexes than the other patients with PE (P = 0.046).
Although the Wells and simplified revised Geneva scores are used widely for assessing clinical probability of PE, these scores may not necessarily correlate with the severity of PE. The Wells score had a weak correlation and may somehow predict the severity of PE. Malignancy is a significant risk factor found to be correlated with more severe PE.

An osteoma may originate from cartilage or embryonal periosteum. It may occur externally or within the paranasal sinuses. In most cases, a paranasal osteoma is a solitary lesion and is located in a single sinus. A double osteoma with maxillary sinusitis is rare. A 54-year-old woman was referred for evaluation and treatment of a right maxillary sinus bony lesion. She complained of headache and foul smell after sneezing since 1 month ago. Panoramic radiography revealed two radiopaque masses in the right maxillary sinus. Cone beam computerized tomography images revealed radiopacities with partially corticated borders attached to the medial wall of the right maxillary sinus, near-complete radiopacification of the right maxillary sinus, and peripheral bony thickening due to chronic sinusitis. On histopathologic examination, the removed radiopaque masses were diagnosed as osteomas.

Invasive papillary carcinoma of the breast is a rare form of breast carcinoma. Hereby we report a case of invasive papillary carcinoma of the breast in a 76-year-old otherwise healthy male, who presented at our department with the complaint of left subareolar masses. Mammography demonstrated two masses that were oval and round shaped, sharply demarcated and with micro calcifications on the internal structure. Ultrasonographic (US) analysis revealed solid mass lesions in the left subareolar location. These lesions had cystic areas in the interior structures. Color Doppler US revealed a high resistant vascularization in the central and peripheral parts of the lesions. Pathological examination of the specimen revealed the intracystic component to be invasive papillary carcinoma. In focal areas there was also findings of neuroendocrine differentiation. The patient underwent total mastectomy following an excisional biopsy, as the surgical margin after biopsy was positive for carcinoma. Axillary dissections had negative lymph nodes. After adjuvant chemotherapy and at the 2-year follow-up examination there were no recurrences or metastases. A high index of suspicion is necessary in male patients with solid lesions with cystic components.

Metastatic involvement of the breast from an extra-mammary tumor is rare. However, when a patient with a known primary malignancy complains of a palpable breast mass, both the primary breast cancer and the metastatic lesion must be considered as a differential diagnosis. Melanoma is one of the tumors that commonly metastasizes to the breast, but the characteristic imaging features are not well known. Therefore, an understanding of the characteristic image findings for melanoma would be advantageous in differentiating a breast mass in patients with a history of melanoma.
A 73-year-old woman with a history of recurring melanoma in the nasal cavity presented with a palpable mass in the left breast. She had undergone various imaging studies, which revealed two masses in the left breast and an enlarged right intramammary lymph node. The patient underwent lumpectomy of masses in the left breast for tissue confirmation, and pathologic examination revealed metastatic melanoma.
Melanoma exhibits typical signal intensity on MRI and commonly metastasizes to the breast. Therefore, it is important to be aware of the characteristic imaging findings for metastatic melanoma, particularly when a melanoma patient presents with a breast lump.

Branchial cleft cyst carcinoma (BCCC) is an extremely rare malignancy originating from cells within the branchial cleft cyst wall. A 73-year-old man presented with a cystic mass with cellulitis mimicking abscess initially and recurred 3 years later as complex cystic lesion in right neck level II with multiple necrotic ipsilateral lymphadenopathy. The pathological diagnosis of cystic lesion was squamous cell carcinoma, suggesting possibility of originating from branchial cleft cyst. There was no identifiable primary cancer elsewhere by a thorough evaluation; eventually final diagnosis was branchial cleft cyst carcinoma to meet the modified criteria of Khafif et al. Up to the present time, there has been no evidence of recurrence. Although the BCCC is very rare, accurate diagnosis is important to plan proper treatment for patient. This report should help increase awareness of BCCC, which should be included in the differential diagnosis of a cystic neck mass.

Sparganosis is a rare parasitic infection caused by ingesting plerocercoid larvae in impure water or consuming raw intermediate hosts such as frogs and snakes. The breast is a rare site of infection. Breast sparganosis usually presents as a migrating subcutaneous mass that clinically and radiologically mimics malignancy. Herein, we report a surgically confirmed case of breast sparganosis mimicking ipsilateral breast tumor recurrence (IBTR) in a patient with a history of breast conserving surgery (BCS) for breast cancer with multimodal imaging findings.