Contrast-enhanced spectral mammography in patients with MRI contraindications

2017 ◽  
Vol 59 (7) ◽  
pp. 798-805 ◽  
Author(s):  
Vivien Richter ◽  
Valerie Hatterman ◽  
Heike Preibsch ◽  
Sonja D Bahrs ◽  
Markus Hahn ◽  
...  
Keyword(s):  
Problem Solving ◽  
Diagnostic Accuracy ◽  
Breast Imaging ◽  
Diagnostic Yield ◽  
Therapy Response ◽  
Lesion Size ◽  
Size Estimation ◽  
Imaging Data ◽  
Technical Problems ◽  
Contrast Enhanced

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method’s technical limitations.

scholarly journals Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

2020 ◽  
Author(s):  
Yan Shen ◽  
Jie He ◽  
Miao Liu ◽  
Jiaojiao Hu ◽  
Yonglin Wan ◽  
...  
Keyword(s):  
Shear Wave ◽  
Breast Imaging ◽  
Imaging Techniques ◽  
Shear Wave Elastography ◽  
Roc Curves ◽  
Imaging Data ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Small Breast ◽  
Contrast Enhanced

Abstract Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with the Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This retrospective study aimed to evaluate the use of CEUS and SWE for the differentiation of benign from malignant small (≤ 2 cm) breast nodules.Methods: We reviewed the medical records and imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. The BI-RADS classification values of the nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison of the pathology results. Receiver operating characteristic (ROC) curves were analyzed based on the CEUS patterns and shear-wave velocity values of the nodules. The sensitivity, specificity, positive and negative predictive values, accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign and malignant small breast nodules were investigated.Results: CEUS was effective at diagnosing malignant nodules when at least two out of nine suspicious features were present. ROC analysis revealed that the best cut-off value for SWE was at 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both, CEUS and SWE were used, and remained unchanged when either one, CEUS or SWE was used; the highest and lowest levels were of category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A classification avoided the need for coarse needle biopsies.Conclusions: CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of the breast nodules, and a combination of these techniques may provide more diagnostic efficacy for identifying malignancy in small breast nodules.Trial registration: Retrospectively registered.

scholarly journals Positive molecular breast imaging: challenges and problem solving with contrast-enhanced spectral mammography

2019 ◽  
Vol 12 (10) ◽  
pp. e230043
Author(s):  
Jeremy SL Ong ◽  
Felicity Whitewood ◽  
Donna B Taylor ◽  
Deepthi Dissanayake
Keyword(s):  
Problem Solving ◽  
Breast Imaging ◽  
Cross Correlation ◽  
High Sensitivity ◽  
Full Field ◽  
Molecular Breast Imaging ◽  
Full Field Digital Mammography ◽  
Contrast Enhanced ◽  
Hypervascular Lesion ◽  
Anatomical Information

Molecular breast imaging (MBI) is a relatively new technique with high sensitivity for breast cancer detection. However, because it only provides limited anatomical information, cross-correlation of MBI findings with conventional breast imaging modalities such as full field digital mammography can be challenging. We report a case of a positive MBI study in a supplemental screening setting, where cross-correlation of MBI, ultrasound, mammogram and biopsy findings was difficult. Contrast-enhanced spectral mammography (CESM) demonstrated a hypervascular lesion at the biopsy clip, helping to prove imaging/histopathological concordance. This case highlights the challenges of incorporating MBI into conventional imaging workup, as well as the use of CESM in problem solving.

scholarly journals Rationale of Using Dynamic Imaging for Characterization of Suspicious Lung Masses into Benign or Malignant on Contrast Enhanced Multi Detector Computed Tomography

2017 ◽  
Vol 7 ◽  
pp. 24 ◽  
Author(s):  
Sachin Khanduri ◽  
Saurav Bhagat ◽  
Parul Shokeen ◽  
Girjesh Kumar ◽  
Shobha Khanduri ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Diagnostic Yield ◽  
Dynamic Imaging ◽  
Receiver Operating Curve ◽  
Relative Percentage ◽  
Contrast Enhanced ◽  
Computed Tomography Scanning ◽  
Histopathological Evaluation ◽  
Sensitivity Specificity

Objectives: To assess the utility of dynamic imaging namely, wash-in and wash-out characteristics through multidetector contrast-enhanced computed tomography in differentiating benign and malignant pulmonary masses. Materials and Methods: Seventy-three patients who were suspected to have malignant pulmonary mass on the basis of clinical symptoms and chest radiograph were included in the study. All the patients underwent multidetector computed tomography scanning, and three series of images were obtained for each patient-noncontrast, early enhanced, and 15 min delayed enhanced scans. Computed tomography (CT) findings were assessed in terms of washin, absolute, and relative percentage washout of contrast. Biopsy of the mass was done and sent for histopathological evaluation. Sensitivity, specificity, and area under curve for diagnosing malignancy in the lung masses were calculated by considering both the wash-in and wash-out characteristics at dynamic CT and plotting the receiver operating curve after the final diagnosis which was obtained by histopathological evaluation. Results: Threshold net enhancement (washin) value of >22.5 HU had sensitivity, specificity, and diagnostic accuracy of 88.5%, 57.1%, and 82%, respectively, in predicting malignancy. Threshold relative percentage washout of <16.235% had 98.1%, 85.7%, and 94% sensitivity, specificity, and diagnostic accuracy, respectively, and threshold absolute percentage washout of <42.72% had 98.1%, 95.2%, and 95% sensitivity, specificity, and diagnostic accuracy, respectively, in predicting malignancy. Conclusion: Threshold net enhancement (washin), absolute and relative washout percentages can be used to predict malignancy with very high diagnostic yield, and possibly obviate the need of invasive procedures for diagnosis of bronchogenic carcinoma.

scholarly journals Mammographic Breast Density: it’s Role in Tumor Size Assessment with Imaging Techniques

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Linear Regression ◽  
Breast Density ◽  
Tumor Size ◽  
Breast Imaging ◽  
Imaging Techniques ◽  
Automatic Measurement ◽  
Mammographic Breast Density ◽  
Size Estimation ◽  
Imaging Data ◽  
Mean Size

Aims: To study the visual and automatic measurement of mammographic breast density (MBD) and its implications in tumor size assessment using distinct imaging techniques. Methods: Retrospective, observational study of the visual and automatic measurement of mammographic breast density according to the breast imaging data system (BI-RADS) in 212 patients with invasive unifocal breast cancer, excluding microinvasive lesions, who did not receive neoadjuvant chemotherapy. Tumor size assessment is compared using a linear regression according pathologic size with mammographic, US and MR size. The influence of MBD in each technique of pathologic size was seen by Bland-Altman plot. Results: Patient’s mean age was 55, 7±9.9 year-old. The mean size of the lesion stablished by mammography was 16.8± 10.4 (4 -70) mm, by US was 13.6±7.2 (5 – 55) mm and by MR 17.2 ±9.9 (5 – 66) mm. Mean pathologic size was 12.6 ±8.1 (0.3 – 55) mm. Automatic MBD mean was 25.2±16.78. BIRAD assessment with visual and automatic MBD measurements were correlated with a tendency of tumor size overestimation with visual method. Linear regression of tumor size according image techniques with pathologic size showed an adjusted r-square of 27.3% for mammography, 41.8% for US and 51.7% for MR. The best correlation was seen with MR although has a tendency to overestimate tumor size. Only tumor size assessed by mammography was influenced by MBD. With this technique, tumor size was best adjusted for those breasts with lower MBD. Conclusion: Visual measurement overestimates MBD versus automatic measurement according BIRADS categories. MR is the more accurate breast imaging technique for assessing tumor size independently of the BMD, which only influences in the mammographic tumor size estimation.

scholarly journals Diagnostic accuracy of contrast-enhanced digital mammography in comparison with sonomammography for characterization of focal asymmetries

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Gelan Ali Mahmoud Soliman ◽  
Shaimaa Abdelsattar Mohammad ◽  
Mohamed El-Shinawi ◽  
Nermeen Nasry Keriakos
Keyword(s):  
Diagnostic Accuracy ◽  
Digital Mammography ◽  
Breast Imaging ◽  
Normal Tissue ◽  
Normal Breast ◽  
Ultrasound Evaluation ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Mass Enhancement

Abstract Background Mammographic focal asymmetry represents normal breast tissue, benign, or malignant lesions. Accurate characterization is important for better management. The study evaluates diagnostic accuracy of contrast-enhanced digital mammography (CEDM) for characterization of focal asymmetries seen in 2D mammography. Results The study was done prospectively on 38 females among 360 patients who underwent baseline sonomammographic assessment for diagnostic and screening purposes. Complementary ultrasound was performed only when a finding was detected in cases of screening mammograms. Focal asymmetries were evaluated according to Breast Imaging Reporting and Data System (BI-RADS) lexicon 2013. CEDM was performed and followed by ultrasound (US) guided core biopsy for solid lesions or aspiration for cystic lesions. CEDM processing resulted in recombined image showing enhancing abnormality. Low energy image and recombined image findings were analyzed blindly and classified into focus enhancement, mass enhancement, non-mass enhancement, and non-enhanced lesions. CEDM and sonomammography findings were compared regarding pathological probability and multiplicity. Histopathology was the reference standard. Mass enhancement showed strong correlation with malignant pathology. Non-mass enhancement showed no correlation with particular pathology. All non-enhanced focal asymmetries were benign in pathology or normal tissue. Rim enhancement needed second look ultrasound evaluation. CEDM was superior to sonomammography with higher sensitivity (77.8%, 65.7% respectively), NPV (0.8, 0.6), accuracy (0.6, 0.2) but lower specificity (81.8% vs. 100%). Multiplicity detection by CEDM was 26.3% and by sonomammography was 10.5%. Conclusion CEDM is more accurate than sonomammography in determination of normal tissue, benign, or malignant lesions in cases of mammographic focal asymmetry. CEDM is more accurate in detection of multiplicity. Undesired biopsies were avoidable with proper management of suspicious and malignant lesions.

scholarly journals CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
M J Wilkinson ◽  
H Snow ◽  
K Downey ◽  
K Thomas ◽  
A Riddell ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Multivariable Analysis ◽  
Ct Scans ◽  
Non Invasive ◽  
Poor Predictor ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Node Metastases

Abstract Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

scholarly journals The Usefulness of Spectral Mammography in Surgical Planning of Breast Cancer Treatment—Analysis of 999 Patients with Primary Operable Breast Cancer

2021 ◽  
Vol 28 (4) ◽  
pp. 2548-2559
Author(s):  
Andrzej Lorek ◽  
Katarzyna Steinhof-Radwańska ◽  
Anna Barczyk-Gutkowska ◽  
Wojciech Zarębski ◽  
Piotr Paleń ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Predictive Value ◽  
Breast Imaging ◽  
Incidence Rates ◽  
Diagnostic Sensitivity ◽  
Breast Cancer Surgery ◽  
Imaging Method ◽  
Treatment Change ◽  
Contrast Enhanced ◽  
General Number

Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.

scholarly journals Quantitative Analysis of the Time–Intensity Curve of Contrast-Enhanced Ultrasound of the Liver: Differentiation of Benign and Malignant Liver Lesions

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1244
Author(s):  
Sonja Schwarz ◽  
Dirk-André Clevert ◽  
Michael Ingrisch ◽  
Thomas Geyer ◽  
Vincent Schwarze ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diagnostic Accuracy ◽  
Late Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Benign Liver ◽  
Benign Liver Lesions

Background: To evaluate the diagnostic accuracy of quantitative perfusion parameters in contrast-enhanced ultrasound to differentiate malignant from benign liver lesions. Methods: In this retrospective study 134 patients with a total of 139 focal liver lesions were included who underwent contrast enhanced ultrasound (CEUS) between 2008 and 2018. All examinations were performed by a single radiologist with more than 15 years of experience using a second-generation blood pool contrast agent. The standard of reference was histopathology (n = 60), MRI or CT (n = 75) or long-term CEUS follow up (n = 4). For post processing regions of interests were drawn both inside of target lesions and the liver background. Time–intensity curves were fitted to the CEUS DICOM dataset and the rise time (RT) of contrast enhancement until peak enhancement, and a late-phase ratio (LPR) of signal intensities within the lesion and the background tissue, were calculated and compared between malignant and benign liver lesion using Student’s t-test. Quantitative parameters were evaluated with respect to their diagnostic accuracy using receiver operator characteristic curves. Both features were then combined in a logistic regression model and the cumulated accuracy was assessed. Results: RT of benign lesions (14.8 ± 13.8 s, p = 0.005), and in a subgroup analysis, particular hemangiomas (23.4 ± 16.2 s, p < 0.001) differed significantly to malignant lesions (9.3 ± 3.8 s). The LPR was significantly different between benign (1.59 ± 1.59, p < 0.001) and malignant lesions (0.38 ± 0.23). Logistic regression analysis with RT and LPR combined showed a high diagnostic accuracy of quantitative CEUS parameters with areas under the curve of 0.923 (benign vs. malignant) and 0.929 (hemangioma vs. malignant. Conclusions: Quantified CEUS parameters are helpful to differentiate malignant from benign liver lesions, in particular in case of atypical hemangiomas.

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