The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use

AbstractContrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

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The Diagnostic Value of Contrast-enhanced 2D Mammography in Everyday Clinical use

10.21203/rs.3.rs-612897/v1 ◽

2021 ◽

Author(s):

Lidewij Neeter ◽

Frank Raat ◽

Stephanie Meens-Koreman ◽

Rogier van Stiphout ◽

Steffie Timmermans ◽

...

Keyword(s):

Diagnostic Performance ◽

Diagnostic Value ◽

Low Energy ◽

Response Monitoring ◽

Full Field ◽

Full Field Digital Mammography ◽

Contrast Enhanced ◽

One Year ◽

Histopathological Results

Abstract Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system.We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination , for all readers independently as well as combined. Breast cancer was diagnosed in 23% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3% to 87.6% (p<0.0001), specificity from 87.8% to 94.6% (p=0.0146). AUC increased from 0.872 to 0.957 (p=0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

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Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery

Cancers ◽

10.3390/cancers12123495 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3495

Author(s):

Jill Gluskin ◽

Carolina Rossi Saccarelli ◽

Daly Avendano ◽

Maria Adele Marino ◽

Almir G. V. Bitencourt ◽

...

Keyword(s):

Breast Cancer ◽

Breast Conserving Surgery ◽

Low Energy ◽

Breast Cancer Patients ◽

Full Field ◽

Full Field Digital Mammography ◽

Institutional Review ◽

Asymptomatic Patients ◽

Contrast Enhanced ◽

One Year

To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.

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Low energy mammogram obtained in contrast-enhanced digital mammography (CEDM) is comparable to routine full-field digital mammography (FFDM)

European Journal of Radiology ◽

10.1016/j.ejrad.2014.05.015 ◽

2014 ◽

Vol 83 (8) ◽

pp. 1350-1355 ◽

Cited By ~ 65

Author(s):

Mark A. Francescone ◽

Maxine S. Jochelson ◽

D. David Dershaw ◽

Janice S. Sung ◽

Mary C. Hughes ◽

...

Keyword(s):

Digital Mammography ◽

Low Energy ◽

Full Field ◽

Full Field Digital Mammography ◽

Contrast Enhanced

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Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria

European Radiology ◽

10.1007/s00330-015-3695-2 ◽

2015 ◽

Vol 25 (10) ◽

pp. 2813-2820 ◽

Cited By ~ 50

Author(s):

U. C. Lalji ◽

C. R. L. P. N. Jeukens ◽

I. Houben ◽

P. J. Nelemans ◽

R. E. van Engen ◽

...

Keyword(s):

Image Quality ◽

Digital Mammography ◽

Quality Criteria ◽

Low Energy ◽

Full Field ◽

Full Field Digital Mammography ◽

Contrast Enhanced

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Quantitative Assessment of Iodine Intensity of Different Types of Lesions in the Low-Energy (LE) Images of Contrast-Enhanced Spectral Mammography (CESM)

Radiology and Medical Diagnostic Imaging ◽

10.31487/j.rdi.2021.02.01 ◽

2021 ◽

pp. 1-5

Author(s):

Sachila Niroshani ◽

Tokiko Nakamura ◽

Nikaidou Michiru ◽

Toru Negishi

Keyword(s):

Iodine Concentration ◽

Low Energy ◽

Fatty Tissue ◽

Full Field ◽

Mean Intensity ◽

Full Field Digital Mammography ◽

Contrast Enhanced ◽

Different Types ◽

The One ◽

Minimum Intensity

Purpose: To assess the iodine enhancement intensity of breast lesions in low energy (LE) images obtained in contrast-enhanced spectral mammography (CESM) with different tissue compositions. Materials and Methods: A 50 mm dedicated phantom with different lesion insert and iodine insert were used to assess the enhancement intensity quantitatively. The target slab of the phantom consists of three lesions + iodine inserts together and 100% adipose equivalent,100% glandular equivalent inserts alone to mimic the adipose and glandular lesion without contrast-enhancement. Each iodine inserts having a concentration of 0.5 mgI/cm3, 1.0 mgI/cm3, 2.0 mgI/cm3. The phantom was exposed under semiautomated function at 28 kV, 30 kV, and 32 kV with Mo/Rh target/filter combination. Iodine intensity was estimated for three types of lesions at three breast equivalent compositions. Results: Lesions with fatty tissue had high intensity while lesions with glandular tissues had the minimum intensity. Among fatty lesions, highest mean intensity value (0.972±0.003) observed with minimum iodine concentration (F + 0.5 mgI/cm3). The highest mean intensity value (0.882±0.001) was found related to the glandular lesion with maximum iodine concentration (G + 2.0 mgI/cm3). The one-way ANOVA statistical test confirmed that mean intensity values were significantly varied among different lesions (P < 0.05). Conclusion: LE images obtained in CESM can be used to identify the different types of lesions without performing the full field digital mammography (FFDM) as an additional examination prior to the CESM procedure.

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Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture—Part II of an Observational Study

Medicina ◽

10.3390/medicina57060584 ◽

2021 ◽

Vol 57 (6) ◽

pp. 584

Author(s):

Puck C. R. van der Vet ◽

Jip Q. Kusen ◽

Manuela Rohner-Spengler ◽

Björn-Christian Link ◽

Roderick M. Houwert ◽

...

Keyword(s):

Quality Of Life ◽

Fall Risk ◽

Fear Of Falling ◽

Low Energy ◽

Activity Levels ◽

Activity Restriction ◽

One Year ◽

Falls In Elderly

Background and objective: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients’ lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. Materials and Methods: Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. Results: 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; p < 0.001) was found. High FoF correlated with lower activity levels (R= −0.288; p < 0.001). Six percent visited the FPP. Conclusions: At follow-up, 40% suffered from FoF which seems to negatively affect patients’ QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.

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MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

10.36106/ijsr/5430960 ◽

2021 ◽

pp. 87-89

Author(s):

Yamen Jabri ◽

Md Mahfooz Buksh ◽

Alicia Skrervin

Keyword(s):

Operative Treatment ◽

Open Surgery ◽

Ct Scanning ◽

Disease Recurrence ◽

Diagnostic Value ◽

Complicated Appendicitis ◽

Risk Patients ◽

Risk Of Disease ◽

One Year

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

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Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000480 ◽

2018 ◽

Vol 5 (5) ◽

pp. e480 ◽

Cited By ~ 12

Author(s):

Kianush Karimian-Jazi ◽

Brigitte Wildemann ◽

Ricarda Diem ◽

Daniel Schwarz ◽

Thomas Hielscher ◽

...

Keyword(s):

Diagnostic Value ◽

Contrast Administration ◽

Signal Ratio ◽

T2 Lesions ◽

Normal Appearing White Matter ◽

Standardized Protocol ◽

Contrast Enhanced ◽

Fluid Attenuated Inversion Recovery ◽

Cranial Mri

ObjectiveTo assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable.MethodsWe included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years). MRI was performed at 3 Tesla with a standardized protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced sequences. Images were analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by 3 independent neuroradiologists. Isolated Gd-enhancing lesions without correlate in T2 and FLAIR images, and reactivated Gd+ lesions were further assessed for size and signal intensity.ResultsWe identified a total of 343 new T2 lesions and 152 CE lesions in a total of 559 MRI follow-up examinations. New T2/FLAIR lesions were present in 30% of the scans. Of the Gd-enhancing lesions, 145/152 (95.4%) showed a correlate as a new T2/FLAIR lesion. There were 3 enhancing lesions (1.9% of all enhancing lesions) without T2/FLAIR correlate and 4 lesions (2.6%) that exhibited lesion reactivation or persistent enhancement over time. As a predictive factor of enhancement, we found that enhancing lesions had a higher T2 signal ratio (T2 SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ± 0.1, p < 0.001).ConclusionThe likelihood of missing “active lesions” is overall small (1.7%) if T2 lesions are stable compared with the previous MRI examination. Lesion reactivation is rare. Our study indicates that Gd contrast administration might be dispensable in follow-up MRI of patients with MS if no new T2/FLAIR lesions and no new neurologic symptoms are present.

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The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria

British Journal of Radiology ◽

10.1259/bjr.20200880 ◽

2021 ◽

Vol 94 (1120) ◽

pp. 20200880

Author(s):

Fan Zhang ◽

Lifang Jin ◽

Gang Li ◽

Chao Jia ◽

Qiusheng Shi ◽

...

Keyword(s):

Diagnostic Criteria ◽

Sensitivity And Specificity ◽

Breast Imaging ◽

Diagnostic Value ◽

Binary Logistic Regression Analysis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Histopathological Results

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. Methods: A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. Results: Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. Conclusions: CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. Advances in knowledge: In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.

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