Recent Trends in Screening Breast MRI

Abstract Objective The objective of this study was to assess trends in screening breast MRI utilization among privately insured women in the U.S. from 2007 to 2017. Methods The utilization of screening breast MRI among women aged 25–64 years from January 1, 2007, to December 31, 2017, was obtained using the MarketScan Commercial Database. We used Current Procedural Terminology codes to exclude breast MRI exams performed in women with a new breast cancer diagnosis and in women imaged to assess response to neoadjuvant therapy in the preceding 90 days. During the 11-year study, 351 763 study-eligible women underwent 488 852 MRI scans. Results An overall 55.0% increase in screening breast MRI utilization was observed over the study period, with a steadily increasing trend. The greatest annual increase in percent utilization was from 2007 to 2008 at 16.6%. The highest utilization rate was in 2017, in which 0.4% of women aged 25–64 years underwent screening breast MRI. Of the women who underwent screening MRI with sufficient follow-up, 76.5% underwent only one examination during the study period. Conclusion Utilization of screening breast MRI has increased steadily in the past decade to a peak of 0.4% of adult women. However, an estimated 9% of U.S. women are eligible for high-risk breast MRI screening; thus, utilization falls short of optimal compliance. Further studies to evaluate the barriers to screening compliance may help optimize utilization.

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CLO19-046: Follow-Up and Diagnosis of Breast Incidentalomas on Abdominal and Chest MRI

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7166 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. CLO19-046

Author(s):

Samantha Rios ◽

Kelsey Larson

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Breast Mri ◽

Breast Cancer Diagnosis ◽

Final Diagnosis ◽

Key Word ◽

Improve Rate ◽

Work Up

With the increasing use of medical imaging, it is important to report and appropriately recommend work up for incidental findings. The aim of the study was to understand how often incidental breast findings are identified on MRI chest/abdomen protocols, how these findings are followed, and the final diagnosis (benign vs malignant) of these lesions. A single institution retrospective review was performed of women who underwent abdominal or chest MRI from January 2007–January 2017 for a non–breast cancer reason with a radiologic report containing the key word “breast.” Incidental breast findings were defined as lesions not known or suspected prior to imaging. For all patients where a breast lesion was identified, the radiologic reports, follow-up imaging and procedures, and final breast pathology were reviewed. Descriptive points were analyzed using counts and percentages versus mean with standard deviation where applicable. After review, 261 patients met inclusion and exclusion criteria with demographics in Table 1. Most patients (92%) had a known or benign breast finding, but 8% (n=21) had a breast finding for which follow-up was recommended. Recommendation for follow-up included ultrasound (n=4), mammogram (n=8), per clinician (n=14), and breast MRI (n=2). Only 7/21 (33.3%) completed recommended follow-up: 86% (6/7) had normal imaging and 14% (1/7) had a new breast cancer diagnosed. Thus, the rate of new breast cancer diagnosis from abnormal abdominal or chest MRI was 4.7%. Recommendation for specific imaging follow-up (56%) (mammogram/ultrasound/MRI) in the original MRI report was 39% more likely to be completed versus “per clinician” (17%) recommendation (P=.15). Incidental breast findings on abdominal and chest MRI are uncommon, but follow-up is important to exclude new breast cancer diagnosis. Specific imaging recommendations (versus “per clinician”) appeared to improve rate of follow-up. Prior studies have looked at incidental breast findings on CT but few have assessed breast incidentalomas on abdominal MRIs, with similar rates of new breast cancer diagnosis documented in our study. Studies assessing breast incidentalomas on chest MRIs are lacking. Going forward, multi-institutional studies may further define the rate of breast cancer diagnosis after breast incidentalomas identified on abdominal/chest MRI. In addition, studies focusing on improving follow-up imaging rates are important for patient safety and quality of care.

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Paranasal Sinus Mucocele Clinical, imagistic and biochemical aspects

Revista de Chimie ◽

10.37358/rc.18.8.6513 ◽

2018 ◽

Vol 69 (8) ◽

Author(s):

Doina Vesa ◽

Cristian Martu ◽

Razvan Leata ◽

Ludmila Lozneanu ◽

luminita Radulescu ◽

...

Keyword(s):

Facial Asymmetry ◽

Retrospective Case ◽

Mri Scans ◽

The One ◽

Ethmoid Sinuses ◽

Retrospective Case Study ◽

Cellular Components ◽

Ct And Mri

Paranasal mucoceles are a type of cysts that evolve slowly and are asymptomatic; this poses a difficulty in diagnosing the patient because the symptoms can go unnoticed. The mucocele evolves unpredictably. On the one hand, it can become infected turning into pyoceles and on the other hand, it can invade important regions such as the orbital, cranial or genian regions, creating facial asymmetry. This is a retrospective case study of 37 patients diagnosed with sinus mucoceles, followed up by clinical examination and paraclinical tests such as CT and MRI scans. The biochemical components of the liquid from within the mucocele were analyzed and the following criteria were recorded: NaCl-, Cl-, Na+ and cholesterine as well as cellular components such as mastocytes, macrophages, hematocytes and leucocytes. In all cases, the treatment option was surgery with favorable post-operative and follow-up evaluation. The mucoceles that appeared post-operatively (maxillary and ethmoid sinuses) evolved more rapidly than the mucoceles that were induced byan external injury. Longer follow-up of operated patients permitted a more timely diagnosis of recurrences.

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The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline

Journal of Alzheimer s Disease ◽

10.3233/jad-210188 ◽

2021 ◽

pp. 1-12

Author(s):

Bibek Gyanwali ◽

Celestine Xue Ting Cai ◽

Christopher Chen ◽

Henri Vrooman ◽

Chuen Seng Tan ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Decline ◽

Hippocampal Volume ◽

Intracranial Stenosis ◽

Vascular Lesions ◽

Linear Regression Models ◽

Volume Functional ◽

Mri Scans ◽

The Mean

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. Methods: 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. Results: Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. Conclusion: These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.

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Brain atrophy and clinical characteristics predicting SDMT performance in multiple sclerosis: A 10-year follow-up study

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217321992394 ◽

2021 ◽

Vol 7 (1) ◽

pp. 205521732199239

Author(s):

Cecilie Jacobsen ◽

Robert Zivadinov ◽

Kjell-Morten Myhr ◽

Turi O Dalaker ◽

Ingvild Dalen ◽

...

Keyword(s):

Clinical Data ◽

Grey Matter Volume ◽

Lesion Volume ◽

Information Processing Speed ◽

Disability Status ◽

Mri Scans ◽

Patients At Risk ◽

Magnetic Resonance Imaging Mri ◽

Specific Volumes

Objectives To identify Magnetic Resonance Imaging (MRI), clinical and demographic biomarkers predictive of worsening information processing speed (IPS) as measured by Symbol Digit Modalities Test (SDMT). Methods Demographic, clinical data and 1.5 T MRI scans were collected in 76 patients at time of inclusion, and after 5 and 10 years. Global and tissue-specific volumes were calculated at each time point. For the primary outcome of analysis, SDMT was used. Results Worsening SDMT at 5-year follow-up was predicted by baseline age, Expanded Disability Status Scale (EDSS), SDMT, whole brain volume (WBV) and T2 lesion volume (LV), explaining 30.2% of the variance of SDMT. At 10-year follow-up, age, EDSS, grey matter volume (GMV) and T1 LV explained 39.4% of the variance of SDMT change. Conclusion This longitudinal study shows that baseline MRI-markers, demographic and clinical data can help predict worsening IPS. Identification of patients at risk of IPS decline is of importance as follow-up, treatment and rehabilitation can be optimized.

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Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19

La radiologia medica ◽

10.1007/s11547-021-01390-4 ◽

2021 ◽

Author(s):

Martina Pecoraro ◽

Stefano Cipollari ◽

Livia Marchitelli ◽

Emanuele Messina ◽

Maurizio Del Monte ◽

...

Keyword(s):

Chest Ct ◽

Ct Scans ◽

Imaging Biomarker ◽

Cross Sectional ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

Sectional Analysis ◽

Ct And Mri ◽

Interlobular Septal Thickening

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

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The long-term course of fatigue following breast cancer diagnosis

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00187-9 ◽

2020 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Karin Biering ◽

Morten Frydenberg ◽

Helle Pappot ◽

Niels Henrik Hjollund

Keyword(s):

Breast Cancer ◽

Time Course ◽

Breast Cancer Diagnosis ◽

Patient Characteristics ◽

Repeated Measurements ◽

Diagnosis And Treatment ◽

Persistent Problem ◽

Treatment Regimens ◽

Long Time

Abstract Purpose Fatigue following breast cancer is a well-known problem, with both high and persistent prevalence. Previous studies suffer from lack of repeated measurements, late recruitment and short periods of follow-up. The course of fatigue from diagnosis and treatment to the long-time outcome status is unknown as well as differences in the level of fatigue between treatment regimens. The purpose of this study was to describe the long-time course of fatigue from the time of clinical suspicion of breast cancer, its dependence of patient characteristics and treatment regimens and the comparison with the course of fatigue among women with the same suspicion, but not diagnosed with breast cancer. Methods Three hundred thirty-two women referred to acute or subacute mammography was followed with questionnaires from before the mammography and up to 1500 days. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-20). The women reported their initial level of fatigue before the mammography and thus without knowledge of whether they had cancer or not. Both women with and without cancer were followed. Women with cancer were identified in the clinical database established by Danish Breast Cancer Cooperative Group (DBCG) to collect information on treatment regimen. Results Compared to fatigue scores before diagnosis, women with breast cancer reported a large increase of fatigue, especially in the first 6 months, followed by a slow decrease over time. Despite the long follow-up period, the women with breast cancer did not return to their level of fatigue at time of the mammography. Women without breast cancer, experienced a rapid decrease of fatigue after disproval of diagnosis followed by a steadier period. Conclusions Fatigue is a persistent problem in women diagnosed with breast cancer, even several years following diagnosis and treatment. The women with breast cancer were most affected by fatigue in the first 6 months after diagnosis.

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Health assessments for Indigenous Australians at Orange Aboriginal Medical Service: health problems identified and subsequent follow up

Australian Journal of Primary Health ◽

10.1071/py14120 ◽

2016 ◽

Vol 22 (3) ◽

pp. 233 ◽

Cited By ~ 1

Author(s):

Tegan Dutton ◽

Wendy Stevens ◽

Jamie Newman

Keyword(s):

Medical Service ◽

Pap Smear ◽

Aboriginal Health ◽

Indigenous Australians ◽

Adult Women ◽

Health Issues ◽

Retrospective Audit ◽

Health Assessments ◽

Clinical Records

This study aimed to document the types, management and follow up of health issues identified by all Aboriginal Health Assessments (AHA) performed at Orange Aboriginal Medical Service from 1 January 2011 to 31 December 2012. This was done with a retrospective audit of clinical records. In total, 1169 AHAs were performed: 41% child, 53% adult and 6% older person AHAs. Newly identified health issues were documented in 85% (984). Being overweight (41%; 476) and smoking (26%; 301) were the common risk factors identified. As a result of the AHA, most children who were not up-to-date with their vaccinations received catch-up immunisations; 11% (36) of adult women (n=314) received a Pap smear, although Pap smear status was unknown or not up-to-date for 61% (192); 27% (311) of cases were prescribed new medication; and 1239 referrals were made but only 40% were attended. At 6 months following the AHA, 26% (240) of cases with newly identified health issues were completely managed and followed up, whereas 25% (226) received no follow up. The AHAs are useful for identifying new health issues; however, follow up of the identified health issues should be improved. If AHAs are to improve health outcomes, appropriate management and follow up of the identified health issues are essential.

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Abstract 2568: Cerebral Infarcts in Blacks vs Whites: the Southall and Brent REvisited (SABRE) Multi-ethnic Cohort Study

Stroke ◽

10.1161/str.43.suppl_1.a2568 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Dean Shibata ◽

Therese Tillin ◽

Norman Beauchamp ◽

John Heasman ◽

Wadyslaw Gedroyc ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Health ◽

African Descent ◽

Health Study ◽

Cardiovascular Health Study ◽

Stroke Mortality ◽

Black African ◽

Cerebral Mri ◽

Mri Scans

Introduction: Stroke mortality is doubled in people of Black African descent compared with Whites, but factors responsible for this excess are unclear. We wished to compare infarct like lesions (ILL) on MRI by ethnicity and the role of risk factors. Methods: SABRE is a UK community based multi-ethnic cohort of men and women aged 40-69 years at baseline (1988-1990), and 58-86 years at follow up (2008-2011). At follow up, a questionnaire was completed and investigations performed including resting and ambulatory BP, anthropometry, and bloods for glucose and lipids. Cerebral MRI scans were scored for infarcts independently by two readers according to the Cardiovascular Health Study protocol. Results: Of 2346 Whites, 684 attended follow up, and 590 completed cerebral MRI. Of 801 Blacks (first generation migrants of Black African descent to the UK), 232 attended clinic and 207 completed MRI. Mortality loss was greater in Whites (605, 25%) than Blacks (121, 15%)(p<0.0001), although stroke was more likely the underlying cause in Blacks (23, 19%), than Whites (43, 7%)(p<0.0001) . Baseline systolic/diastolic BP was similarly higher in Blacks than Whites in attendees (8/5 mmHg), non-responders (7/6 mm Hg), and those who died (8/5 mmHg). At follow up stroke risk factors were adverse in Blacks, apart from smoking ( table ). Prevalence of ILL was similar by ethnicity, not differing when those <65 years were analysed separately, or when those with stroke/TIA history were excluded. Associations between ILL and risk factors did not differ by ethnicity. But prescribed treatment in those with elevated clinic BP (≥140 mmHg systolic, or ≥90 mmHg diastolic) was 83% in Blacks, 63% in Whites (p<0.0001). Further, in those with an ILL, 95% of Blacks, and 69% (p<0.0001) of Whites were on treatment. Conclusion: Equivalence of ILL rates in Blacks and Whites was unanticipated, given the greater stroke mortality in Blacks. Mitigating against selective mortality as the explanation of our findings is the similar ethnic differential in baseline BP in survivors and non-survivors, the lower overall mortality in Blacks, and overall small numbers of stroke deaths. A more likely explanation is that better targeted more aggressive treatment is now occurring in Blacks than Whites, reducing their potential burden of ILL.

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Predicting reattendance at a high-risk breast cancer clinic

Palliative & Supportive Care ◽

10.1017/s1478951515000164 ◽

2015 ◽

Vol 13 (5) ◽

pp. 1441-1448 ◽

Cited By ~ 3

Author(s):

Sarah R. Ormseth ◽

David K. Wellisch ◽

Adam E. Aréchiga ◽

Taylor L. Draper

Keyword(s):

Breast Cancer ◽

High Risk ◽

Perceived Risk ◽

Depressive Symptomatology ◽

High Risk Breast Cancer ◽

High Risk Breast ◽

Risk Breast Cancer ◽

Cancer Clinic ◽

High Risk Clinic

AbstractObjective:The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic.Method:Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES–D score ≥ 16), current level of anxiety (State–Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer).Results:A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted “U” relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels.Significance of Results:Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

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