MRI Features of Free Liquid Silicone in the Transgender Female Breast

Objective To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management. Methods This study was IRB–approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using two-tailed Fisher exact and Student’s t test. Results Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4–12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed. Conclusion MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.

Comparing Low and High-Temporal Resolution DCE-MRI Texture Analysis for Discrimination of Breast Lesions from Background Enhancement

Background Breast cancer is the most common cancer in women worldwide, high-resolution dynamic contrast-enhanced MRI (DCE-MRI) can better evaluate the tissue microenvironment and texture characteristics. The purpose of this study was to investigate the value of the texture-based analysis for breast DCE-MRI in the diagnosis of breast lesions and background enhancement. Methods This study prospectively enrolled 128 patients with clinically suspected breast lesions in our hospital from April 2015 to June 2017. Among them, 62 patients underwent preoperative high temporal resolution DCE-MRI (1 + 26 phases) scan with 39 malignant and 23 benign lesions. The control group retrospectively and randomly contained 78 patients who underwent preoperative low temporal resolution DCE-MRI (1 + 5 phases) scans with 46 malignant and 32 benign lesions. Quantitative parameters were obtained using a two-compartment Extended Tofts and volume of interest model for the lesion center, surrounding peripheral area and background enhancement, including pharmacokinetic parameters (Ktrans, Kep, Ve and Vp) and texture features based on the Ktrans map. The Student’s t-test was used to compare the differences of means. LASSO was used for dimension reduction and logistic regression analysis was used for model construction. A receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance. Results Pharmacokinetic parameters were significantly different between high temporal resolution and low temporal resolution DCE-MRI (P < 0.05). In the malignant group, the average Ktrans of the lesion area on high temporal resolution DCE-MRI was significantly correlated to the pathological grading (r = 0.400, P = 0.012). In the differentiation between benign and malignant lesions, the ROC analysis demonstrated that the diagnostic value of high temporal resolution DCE-MRI offered slightly significant advantages in the realms of the lesion, peripheral areas and background enhancement. Conclusions The use of texture analysis based on high temporal resolution DCE-MRI may potentially improve breast cancer diagnostic performance. Specifically, combining the lesion, peripheral, BE area, and Ktrans-mean parameters can contribute to the diagnosis of breast lesions, background enhancement and the pathological grading of malignant tumors.

Dual labeling with 5-aminolevulinic acid and fluorescein in high-grade glioma surgery with a prototype filter system built into a neurosurgical microscope: technical note

OBJECTIVERecent efforts to improve visualization of 5-aminolevulinic acid (5-ALA)–induced protoporphyrin IX (PPIX) fluorescence resulted in a dual-labeling technique, combining it with fluorescein sodium in a prototype setup. Fluorescein identifies regions with blood-brain barrier breakdown in gliomas. However, normally perfused and edematous brain fluoresces unselectively, with strong background enhancement. The aim of this study was to test the feasibility of a novel, integrated filter combination using porphyrins for selective tumor identification and fluorescein for background enhancement.METHODSA microscope with a novel built-in filter system (YB 475) for visualizing both fluorescein and 5-ALA–induced porphyrins was used. Resection limits were identified with the conventional BLUE 400 filter system. Six patients harboring contrast ring-enhancing lesions were analyzed.RESULTSThe complete surgical field could now be illuminated. Fluorescein was helpful for improving background visualization, and enhancing dura, edematous tissue, and cortex. Overlapping regions with both fluorophores harbored merged orange fluorescence. PPIX fluorescence was better visualized, even in areas beyond a normal working distance of approximately 25 cm, where the BLUE 400 filters recognized no or weak fluorescence.CONCLUSIONSThe novel filter system improved general tissue brightness and background visualization, enhancing fluorescence-guided tumor resection. Furthermore, it appears promising from a scientific perspective, enabling the simultaneous and direct observation of areas with blood-brain barrier breakdown and PPIX fluorescence.

Relationship between the pre-operative background enhancement coefficient under MRI of breast cancer and recurrence of postoperative chest wall.

e12091 Background: With the rapid development of MRI scanning technology , DCE-MRI in breast cancer has been one of the most sensitive examinations for the reason of allowing precise imaging, which can be helpful to demonstrate and evaluate the anatomical structures of breast cancer and its surrounding. What is more,through application of postprocessing technique of MRI,quantitative and half-qualitative data can be obtained for the diagnosis and the differential diagnosis of breast cancer. It is reported that the recurrence of breast cancer after breast conserving surgery is related with elevated BEC of MRI before operation as the result of the difficulty to find the micro-lesions and the margin of infiltrative lesions. Objective: Study on the relationship between the background enhancement coefficient of breast cancer under MRI before operation and recurrence of postoperative chest wall. Material and Methods: 194 cases of breast cancer patients undergoing radical surgery were retrospectively analyzed, all of which were confirmed by pathology and molecular classification.Before surgery all the patients did MRI and the BEC was measured.Aim for study on the relevance of the elevated BEC and chest wall recurrence,we investigate the relationship between the stage, grade,molecular subtype of breast cancer and the elevated BEC statistically. Results: The elevated BEC of the breast before operation is associated with chest wall recurrence after operation (P=0.045), and high expression of HER-2 (P=0.07). Multiple lesions of breast cancer and Ki-67>14% also appeared to be associated with the elevated BEC (P=0.08).While there seem to be no correlation between the size of tumor ,LN metastases, nuclear and pathological grade,molecular typing, PR expression,ER expression, status of the LN capsule and the elevated BEC. Conclusions: The elevated BEC of breast before operation is an independent prognostic factor for chest wall recurrence after operation.Given BEC get a potential to make a brand new biomarker for breast cancer,further relevant research is needed.

A Hybrid the Nonsubsampled Contourlet Transform and Homomorphic Filtering for Enhancing Mammograms

Mammogram is important for early breast cancer detection. But due to the low contrast of microcalcifications and noise, it is difficult to detect microcalcification. This paper presents a comparative study in digital mammography image enhancement based on three different algorithms: homomorphic filtering, unsharp masking and our proposed methods. This latter use a hybrid method Combining contourlet and homomorphic filtering. Performance of the given technique has been measured in terms of distribution separation measure (DSM), target-to-background enhancement measure based on standard deviation (TBES) and target-to-background enhancement measure based on entropy (TBEE). The proposed methods were tested with the referents mammography data Base MiniMIAS. Experimental results show that the proposed method improves the visibility of microcalcification.

Case 15.2

61-year-old woman on postmenopausal hormone replacement therapy with 1-year persistent, asymmetrical fullness in the left upper outer breast. Clinical examination and diagnostic mammography were unremarkable The MIP image at peak enhancement with CAD color overlay (Figure 15.2.1) demonstrates mild background enhancement and a mass in the right breast. Axial water image (...