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Hu YH, Scaduto DA, Zhao W. Optimization of contrast-enhanced breast imaging: Analysis using a cascaded linear system model. Med Phys 2017; 44:43-56. [PMID: 28044312 DOI: 10.1002/mp.12004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Contrast-enhanced (CE) breast imaging involves the injection contrast agents (i.e., iodine) to increase conspicuity of malignant lesions. CE imaging may be used in conjunction with digital mammography (DM) or digital breast tomosynthesis (DBT) and has shown promise in improving diagnostic specificity. Both CE-DM and CE-DBT techniques require optimization as clinical diagnostic tools. Physical factors including x-ray spectra, subtraction technique, and the signal from iodine contrast, must be considered to provide the greatest object detectability and image quality. We developed a cascaded linear system model (CLSM) for the optimization of CE-DM and CE-DBT employing dual energy (DE) subtraction or temporal (TE) subtraction. METHODS We have previously developed a CLSM for DBT implemented with an a-Se flat panel imager (FPI) and filtered backprojection (FBP) reconstruction algorithm. The model is used to track image quality metrics - modulation transfer function (MTF) and noise power spectrum (NPS) - at each stage of the imaging chain. In this study, the CLSM is extended for CE breast imaging. The effect of x-ray spectrum (varied by changing tube potential and the filter) and DE and TE subtraction techniques on breast structural noise was measured was studied and included as a deterministic source of noise in the CLSM. From the two-dimensional (2D) and three-dimensional (3D) MTF and NPS, the ideal observer signal-to-noise ratio (SNR), also known as the detectability index (d'), may be calculated. Using d' as a FOM, we discuss the optimization of CE imaging for the task of iodinated contrast object detection within structured backgrounds. RESULTS Increasing x-ray energy was determined to decrease the magnitude of structural noise and not its correlation. By performing DE subtraction, the magnitude of the structural noise was further reduced at the expense of increased stochastic (quantum and electronic) noise. TE subtraction exhibited essentially no residual structural noise at the expense of increased quantum noise, even over that of the DE case. For DE subtraction, optimization of dose weighting to the HE view (fh ) results in the minimization of quantum noise. Both subtraction weighting factor (wSub ) and the iodine contrast signal were dependent on the LE and HE x-ray spectra. To best detect a 5 mm Gaussian lesion with 5 mg/ml of iodine within a 4 cm thick breast, it was found that the high energy (HE) view should be acquired with a tube potential of 47 kVp (W/Ti spectrum) and the low energy (LE) view with a potential of 23 kVp (W/Rh spectrum). Due to the complete removal of structural noise, TE subtraction produced much higher d' than DE subtraction both as a function of mean glandular dose and iodine concentration. CONCLUSIONS We have shown the effect of increasing x-ray energy as well as projection domain subtraction on breast structural noise. Further, we have exhibited the utility of the CLSM for DE and TE subtraction CE imaging in the optimization of imaging parameters such as x-ray energy, fh , and wSub as well as guiding the understanding of their effects on image contrast and noise.
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Affiliation(s)
- Yue-Houng Hu
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, NY, 11794-8460, USA
| | - David A Scaduto
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, NY, 11794-8460, USA
| | - Wei Zhao
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, NY, 11794-8460, USA
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Bhimani C, Matta D, Roth RG, Liao L, Tinney E, Brill K, Germaine P. Contrast-enhanced Spectral Mammography: Technique, Indications, and Clinical Applications. Acad Radiol 2017; 24:84-88. [PMID: 27773458 DOI: 10.1016/j.acra.2016.08.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced spectral mammography (CESM) combines the benefits of full field digital mammography with the concept of tumor angiogenesis. Technique and practical applications of CESM are discussed. MATERIALS AND METHODS An overview of the technique is followed by a demonstration of practical applications of CESM in our practice. RESULTS We have successfully implemented CESM into our practice as a screening, diagnostic, staging, and treatment response tool. CONCLUSION It is important to understand the technique of CESM and how to incorporate it into practice.
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Bhimani C, Li L, Liao L, Roth RG, Tinney E, Germaine P. Contrast-enhanced Spectral Mammography: Modality-Specific Artifacts and Other Factors Which May Interfere with Image Quality. Acad Radiol 2017; 24:89-94. [PMID: 27765597 DOI: 10.1016/j.acra.2016.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced spectral mammography (CESM) uses full field digital mammography with the added benefit of intravenous contrast administration to significantly reduce false-positive and false-negative results and improve specificity while maintaining high sensitivity. For CESM to fulfill its purpose, one should be aware of possible artifacts and other factors which may interfere with image quality, and attention should be taken to minimize these factors. MATERIALS AND METHODS This pictorial demonstration will depict types of artifacts detected and other factors that interfere with image acquisition in our practice since CESM implementation. RESULTS Many of the artifacts and other factors we have encountered while using CESM have simple solutions to resolve them. CONCLUSION The illustrated artifacts and other factors interfering with image quality will serve as a useful reference to anyone using CESM.
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Łuczyńska E, Niemiec J, Hendrick E, Heinze S, Jaszczyński J, Jakubowicz J, Sas-Korczyńska B, Rys J. Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results. Med Sci Monit 2016; 22:3886-3893. [PMID: 27768681 PMCID: PMC5077289 DOI: 10.12659/msm.900371] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Contrast enhanced spectral mammography (CESM) is a new method of breast cancer diagnosis in which an iodinated contrast agent is injected and dual-energy mammography is obtained in multiple views of the breasts. The aim of this study was to compare the degree of enhancement on CESM with lesion characteristics on mammography (MG) and lesion histology in women with suspicious breast lesions. Material/Methods The degree of enhancement on CESM (absent, weak, medium, or strong) was compared to lesion characteristics on MG (mass, mass with microcalcifications, or microcalcifications alone) and histology (infiltrating carcinoma, intraductal carcinoma, or benign) to compare sensitivity of the two modalities and to establish correlations that might improve diagnostic accuracy. Results Among 225 lesions identified with CESM and MG, histological evaluation revealed 143 carcinomas (127 infiltrating, 16 intraductal) and 82 benign lesions. This is the largest cohort investigated with CESM to date. The sensitivity of CESM was higher than that of MG (100% and 90%, respectively, p=0.010). Medium or strong enhancement on CESM and the presence of a mass on MG was the most likely indictor of malignancy (55.1% p=0.002). Among benign lesions, 60% presented as enhancement on CESM (were false-positive), and most frequently as medium or weak enhancement, together with a mass on MG (53%, p=0.047). Unfortunately, the study did not find combinations of MG findings and CESM enhancement patterns that would be helpful in defining false-positive lesions. We observed systematic overestimation of maximum lesion diameter on CESM compared to histology (mean difference: 2.29 mm). Conclusions Strong or medium enhancement on CESM and mass or mass with microcalcifications on MG were strong indicators of malignant transformation. However, we found no combination of MG and CESM characteristics helpful in defining false-positive lesions.
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Affiliation(s)
- Elżbieta Łuczyńska
- Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Joanna Niemiec
- Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Edward Hendrick
- Department of Radiology, School of Medicine, University of Colorado, Denver, Aurora, CO, USA
| | - Sylwia Heinze
- Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Jaszczyński
- Department of Urology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Jerzy Jakubowicz
- Oncology Clinic and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Beata Sas-Korczyńska
- Oncology Clinic and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Rys
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
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Lewis TC, Pizzitola VJ, Giurescu ME, Eversman WG, Lorans R, Robinson KA, Patel BK. Contrast-enhanced Digital Mammography: A Single-Institution Experience of the First 208 Cases. Breast J 2016; 23:67-76. [PMID: 27696576 DOI: 10.1111/tbj.12681] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Contrast-enhanced digital mammography (CEDM) is the only imaging modality that provides both (a) a high-resolution, low-energy image comparable to that of digital mammography and (b) a contrast-enhanced image similar to that of magnetic resonance imaging. We report the initial 208 CEDM examinations performed for various clinical indications and provide illustrative case examples. Given its success in recent studies and our experience of CEDM primarily as a diagnostic adjunct, CEDM can potentially improve breast cancer detection by combining the low-cost conclusions of screening mammography with the high sensitivity of magnetic resonance imaging.
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Affiliation(s)
| | | | | | | | - Roxanne Lorans
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona
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Ali-Mucheru M, Pockaj B, Patel B, Pizzitola V, Wasif N, Stucky CC, Gray R. Contrast-Enhanced Digital Mammography in the Surgical Management of Breast Cancer. Ann Surg Oncol 2016; 23:649-655. [DOI: 10.1245/s10434-016-5567-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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Kariyappa KD, Gnanaprakasam F, Anand S, Krishnaswami M, Ramachandran M. Contrast enhanced dual energy spectral mammogram, an emerging addendum in breast imaging. Br J Radiol 2016; 89:20150609. [PMID: 27610475 DOI: 10.1259/bjr.20150609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the role of contrast-enhanced dual-energy spectral mammogram (CEDM) as a problem-solving tool in equivocal cases. METHODS 44 consenting females with equivocal findings on full-field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three-point Likert scale and probability of cancer was assigned on Breast Imaging Reporting and Data System scoring. Histopathology was taken as the gold standard. Statistical analyses of all variables were performed. RESULTS 44 breast lesions were included in the study, among which 77.3% lesions were malignant or precancerous and 22.7% lesions were benign or inconclusive. 20% of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9% of cases, multifocality was established in 9.1% of cases and ductal extension was demonstrated in 6.8% of cases. Statistical significance for CEDM was p-value <0.05. Interobserver kappa value was 0.837. CONCLUSION CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence, we conclude that CEDM is a useful complementary tool to standard mammogram. Advances in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with the advantage of feasibility of stereotactic biopsy in the same setting. Hence, it has the potential to be a screening modality with need for further studies and validation.
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Affiliation(s)
- Kalpana D Kariyappa
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Francis Gnanaprakasam
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Subhapradha Anand
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Murali Krishnaswami
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Madan Ramachandran
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
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Brandan ME, Cruz-Bastida JP, Rosado-Méndez IM, Villaseñor-Navarro Y, Pérez-Ponce H, Galván HA, Trujillo-Zamudio FE, Sánchez-Suárez P, Benítez-Bribiesca L. Clinical study of contrast-enhanced digital mammography and the evaluation of blood and lymphatic microvessel density. Br J Radiol 2016; 89:20160232. [PMID: 27376457 DOI: 10.1259/bjr.20160232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To correlate image parameters in contrast-enhanced digital mammography (CEDM) with blood and lymphatic microvessel density (MVD). METHODS 18 Breast Imaging-Reporting and Data System (BI-RADS)-4 to BI-RADS-5 patients were subjected to CEDM. Craniocaudal views were acquired, two views (low and high energy) before iodine contrast medium (CM) injection and four views (high energy) 1-5 min afterwards. Processing included registration and two subtraction modalities, traditional single-energy temporal (high-energy) and "dual-energy temporal with a matrix", proposed to improve lesion conspicuity. Images were calibrated into iodine thickness, and iodine uptake, contrast, time-intensity and time-contrast kinetic curves were quantified. Image indicators were compared with MVD evaluated by anti-CD105 and anti-podoplanin (D2-40) immunohistochemistry. RESULTS 11 lesions were cancerous and 7 were benign. CEDM subtraction strongly increased conspicuity of lesions enhanced by iodine uptake. A strong correlation was observed between lymphatic vessels and blood vessels; all benign lesions had <30 blood microvessels per field, and all cancers had more than this value. MVD showed no correlation with iodine uptake, nor with contrast. The most frequent curve was early uptake followed by plateau for uptake and contrast in benign and malignant lesions. The positive-predictive value of uptake dynamics was 73% and that of contrast was 64%. CONCLUSION CEDM increased lesion visibility and showed additional features compared with conventional mammography. Lack of correlation between image parameters and MVD is probably due to tumour tissue heterogeneity, mammography projective nature and/or dependence of extracellular iodine irrigation on tissue composition. ADVANCES IN KNOWLEDGE Quantitative analysis of CEDM images was performed. Image parameters and MVD showed no correlation. Probably, this is indication of the complex dependence of CM perfusion on tumour microenvironment.
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Affiliation(s)
- María-Ester Brandan
- 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan P Cruz-Bastida
- 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Iván M Rosado-Méndez
- 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Héctor Pérez-Ponce
- 1 Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Sogani J, Morris EA, Kaplan JB, D'Alessio D, Goldman D, Moskowitz CS, Jochelson MS. Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging. Radiology 2016; 282:63-73. [PMID: 27379544 DOI: 10.1148/radiol.2016160284] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose To assess the extent of background parenchymal enhancement (BPE) at contrast material-enhanced (CE) spectral mammography and breast magnetic resonance (MR) imaging, to evaluate interreader agreement in BPE assessment, and to examine the relationships between clinical factors and BPE. Materials and Methods This was a retrospective, institutional review board-approved, HIPAA-compliant study. Two hundred seventy-eight women from 25 to 76 years of age with increased breast cancer risk who underwent CE spectral mammography and MR imaging for screening or staging from 2010 through 2014 were included. Three readers independently rated BPE on CE spectral mammographic and MR images with the ordinal scale: minimal, mild, moderate, or marked. To assess pairwise agreement between BPE levels on CE spectral mammographic and MR images and among readers, weighted κ coefficients with quadratic weights were calculated. For overall agreement, mean κ values and bootstrapped 95% confidence intervals were calculated. The univariate and multivariate associations between BPE and clinical factors were examined by using generalized estimating equations separately for CE spectral mammography and MR imaging. Results Most women had minimal or mild BPE at both CE spectral mammography (68%-76%) and MR imaging (69%-76%). Between CE spectral mammography and MR imaging, the intrareader agreement ranged from moderate to substantial (κ = 0.55-0.67). Overall agreement on BPE levels between CE spectral mammography and MR imaging and among readers was substantial (κ = 0.66; 95% confidence interval: 0.61, 0.70). With both modalities, BPE demonstrated significant association with menopausal status, prior breast radiation therapy, hormonal treatment, breast density on CE spectral mammographic images, and amount of fibroglandular tissue on MR images (P < .001 for all). Conclusion There was substantial agreement between readers for BPE detected on CE spectral mammographic and MR images. © RSNA, 2016.
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Affiliation(s)
- Julie Sogani
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Elizabeth A Morris
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Jennifer B Kaplan
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Donna D'Alessio
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Debra Goldman
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Chaya S Moskowitz
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Maxine S Jochelson
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Tardivel AM, Balleyguier C, Dunant A, Delaloge S, Mazouni C, Mathieu MC, Dromain C. Added Value of Contrast-Enhanced Spectral Mammography in Postscreening Assessment. Breast J 2016; 22:520-8. [DOI: 10.1111/tbj.12627] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Corinne Balleyguier
- Radiology Department; Gustave Roussy; Villejuif France
- UMR 8081, IR4M; Paris-Sud University; Orsay France
| | - Ariane Dunant
- Department of Statstics; Gustave Roussy; Villejuif France
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Deán-Ben XL, Fehm TF, Gostic M, Razansky D. Volumetric hand-held optoacoustic angiography as a tool for real-time screening of dense breast. JOURNAL OF BIOPHOTONICS 2016; 9:253-9. [PMID: 25966021 DOI: 10.1002/jbio.201500008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 05/19/2023]
Abstract
Existing mammographic screening solutions are generally associated with several major drawbacks, such as exposure to ionizing radiation or insufficient sensitivity in younger populations with radiographically-dense breast. Even when combined with ultrasound or magnetic resonance imaging, X-Ray mammography may still attain unspecific or false positive results. Thus, development of new breast imaging tools represents a timely medical challenge. We report on a new approach to high-resolution functional and anatomical breast angiography using volumetric hand-held optoacoustic tomography, which employs light intensities safe for human use. Experiments in young healthy volunteers with fibroglandular-dominated dense breasts revealed the feasibility of rendering three-dimensional images representing vascular anatomy and functional blood oxygenation parameters at video rate. Sufficient contrast was achieved at depths beyond 2 cm within dense breasts without compromising the real-time imaging performance. The suggested solution may thus find applicability as a standalone or supplemental screening tool for early detection and follow-up of carcinomas in radiographically-dense breasts. Volumetric handheld optoacoustic tomography scanner uses safe pulses of near-infrared light to render three-dimensional images of deep vascular anatomy, blood oxygenation and breast parenchyma at video rate.
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Affiliation(s)
- X Luís Deán-Ben
- Institute of Biological and Medical Imaging (IBMI), Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas F Fehm
- Institute of Biological and Medical Imaging (IBMI), Helmholtz Zentrum München, Neuherberg, Germany
- Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Monika Gostic
- Neurogenetics Group, School of Medicine, University of St. Andrews, Scotland, United Kingdom
| | - Daniel Razansky
- Institute of Biological and Medical Imaging (IBMI), Helmholtz Zentrum München, Neuherberg, Germany.
- Faculty of Medicine, Technische Universität München, Munich, Germany.
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Blum K, Antoch G, Mohrmann S, Obenauer S. Use of low-energy contrast-enhanced spectral mammography (CESM) as diagnostic mammography-proof of concept. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aminololama-Shakeri S, Abbey CK, Gazi P, Prionas ND, Nosratieh A, Li CS, Boone JM, Lindfors KK. Differentiation of ductal carcinoma in-situ from benign micro-calcifications by dedicated breast computed tomography. Eur J Radiol 2015; 85:297-303. [PMID: 26520874 DOI: 10.1016/j.ejrad.2015.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/14/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Compare conspicuity of ductal carcinoma in-situ (DCIS) to benign calcifications on unenhanced (bCT), contrast-enhanced dedicated breast CT (CEbCT) and mammography (DM). METHODS AND MATERIALS The institutional review board approved this HIPAA-compliant study. 42 women with Breast Imaging Reporting and Data System 4 or 5 category micro-calcifications had breast CT before biopsy. Three subjects with invasive disease at surgery were excluded. Two breast radiologists independently compared lesion conspicuity scores (CS) for CEbCT, to bCT and DM. Enhancement was measured in Hounsfield units (HU). Mean CS ± standard deviations are shown. Receiver operating characteristic analysis (ROC) measured radiologists' discrimination performance by comparing CS to enhancement alone. Statistical measurements were made using ANOVA F-test, Wilcoxon rank-sum test and robust linear regression analyses. RESULTS 39 lesions (17 DCIS, 22 benign) were analyzed. DCIS (8.5 ± 0.9, n=17) was more conspicuous than benign micro-calcifications (3.6 ± 2.9, n=22; p<0.0001) on CEbCT. DCIS was equally conspicuous on CEbCT and DM (8.5 ± 0.9, 8.7 ± 0.8, n=17; p=0.85) and more conspicuous when compared to bCT (5.3 ± 2.6, n=17; p<0.001). All DCIS enhanced; mean enhancement (90HU ± 53HU, n=17) was higher compared to benign lesions (33 ± 30HU, n=22) (p<0.0001). ROC analysis of the radiologists' CS showed high discrimination performance (AUC=0.94) compared to enhancement alone (AUC=0.85) (p<0.026). CONCLUSION DCIS is more conspicuous than benign micro-calcifications on CEbCT. DCIS visualization on CEbCT is equal to mammography but improved compared to bCT. Radiologists' discrimination performance using CEBCT is significantly higher than enhancement values alone. CEbCT may have an advantage over mammography by reducing false positive examinations when calcifications are analyzed.
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Affiliation(s)
- Shadi Aminololama-Shakeri
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States.
| | - Craig K Abbey
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, United States
| | - Peymon Gazi
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States
| | - Nicolas D Prionas
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States
| | - Anita Nosratieh
- Center for Devices and Radiological Heath, Food and Drug Administration, Wash DC, United States
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, MS1C Room 145, University of California, Davis, CA 95616, United States
| | - John M Boone
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States
| | - Karen K Lindfors
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, United States
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Contrast-enhanced dual energy mammography with a novel anode/filter combination and artifact reduction: a feasibility study. Eur Radiol 2015; 26:1575-81. [DOI: 10.1007/s00330-015-4007-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/27/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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ElSaid NAE, Farouk S, Shetat OMM, Khalifa NM, Nada OM. Contrast enhanced digital mammography: Is it useful in detecting lesions in edematous breast? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hu YH, Zhao W. The effect of amorphous selenium detector thickness on dual-energy digital breast imaging. Med Phys 2015; 41:111904. [PMID: 25370637 DOI: 10.1118/1.4897244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Contrast enhanced (CE) imaging techniques for both planar digital mammography (DM) and three-dimensional (3D) digital breast tomosynthesis (DBT) applications requires x-ray photon energies higher than the k-edge of iodine (33.2 keV). As a result, x-ray tube potentials much higher (>40 kVp) than those typical for screening mammography must be utilized. Amorphous selenium (a-Se) based direct conversion flat-panel imagers (FPI) have been widely used in DM and DBT imaging systems. The a-Se layer is typically 200 μm thick with quantum detective efficiency (QDE) >87% for x-ray energies below 26 keV. However, QDE decreases substantially above this energy. To improve the object detectability of either CE-DM or CE-DBT, it may be advantageous to increase the thickness (dSe) of the a-Se layer. Increasing the dSe will improve the detective quantum efficiency (DQE) at the higher energies used in CE imaging. However, because most DBT systems are designed with partially isocentric geometries, where the gantry moves about a stationary detector, the oblique entry of x-rays will introduce additional blur to the system. The present investigation quantifies the effect of a-Se thickness on imaging performance for both CE-DM and CE-DBT, discussing the effects of improving photon absorption and blurring from oblique entry of x-rays. METHODS In this paper, a cascaded linear system model (CLSM) was used to investigate the effect of dSe on the imaging performance (i.e., MTF, NPS, and DQE) of FPI in CE-DM and CE-DBT. The results from the model are used to calculate the ideal observer signal-to-noise ratio, d', which is used as a figure-of-merit to determine the total effect of increasing dSe for CE-DM and CE-DBT. RESULTS The results of the CLSM show that increasing dSe causes a substantial increase in QDE at the high energies used in CE-DM. However, at the oblique projection angles used in DBT, the increased length of penetration through a-Se introduces additional image blur. The reduced MTF and DQE at high spatial frequencies lead to reduced two-dimensional d'. These losses in projection image resolution may subsequently result in a decrease in the 3D d', but the degree of which is largely dependent on the DBT reconstruction algorithm. For a filtered backprojection (FBP) algorithm with spectral apodization and slice-thickness filters, which dominate the blur for reconstructed images at oblique angles, the effect of oblique entry of x-rays on 3D d' is minimal. Thus, increasing dSe results in an improvement in d' for both CE-DM and CE-DBT with typical FBP reconstruction parameters. CONCLUSIONS Increased dSe improves CE breast imaging performance by increasing QDE of detectors at higher energies, e.g., 49 kVp. Although there is additional blur in the oblique angled projections of a DBT scan, the overall 3D d' for DBT is not degraded because the dominant source blur at these angles results from the reconstruction filters of the employed FBP algorithm.
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Affiliation(s)
- Yue-Houng Hu
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, New York 11794-8460
| | - Wei Zhao
- Department of Radiology, State University of New York at Stony Brook, L-4 120 Health Sciences Center, Stony Brook, New York 11794-8460
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Hobbs MM, Taylor DB, Buzynski S, Peake RE. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. J Med Imaging Radiat Oncol 2015; 59:300-5. [PMID: 25900704 DOI: 10.1111/1754-9485.12296] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Contrast-enhanced spectral mammography (CESM) may have similar diagnostic performance to Contrast-enhanced MRI (CEMRI) in the diagnosis and staging of breast cancer. To date, research has focused exclusively on diagnostic performance when comparing these two techniques. Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable. The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging. METHODS Forty-nine participants who underwent both CESM and CEMRI, as part of a larger trial, completed a Likert questionnaire about their preference for each modality according to the following criteria: comfort of breast compression, comfort of intravenous (IV) contrast injection, anxiety and overall preference. Participants also reported reasons for preferring one modality to the other. Quantitative data were analysed using a Wilcoxon sign-rank test and chi-squared test. Qualitative data are reported descriptively. RESULTS A significantly higher overall preference towards CESM was demonstrated (n = 49, P < 0.001), with faster procedure time, greater comfort and lower noise level cited as the commonest reasons. Participants also reported significantly lower rates of anxiety during CESM compared with CEMRI (n = 36, P = 0.009). A significantly higher rate of comfort was reported during CEMRI for measures of breast compression (n = 49, P = 0.001) and the sensation of IV contrast injection (n = 49, P = 0.003). CONCLUSION Our data suggest that overall, patients prefer the experience of CESM to CEMRI, adding support for the role of CESM as a possible alternative to CEMRI for breast cancer staging.
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Affiliation(s)
- Max M Hobbs
- Royal Perth Hospital Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Donna B Taylor
- Royal Perth Hospital Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sebastian Buzynski
- Royal Perth Hospital Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Rachel E Peake
- School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
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Daniaux M, De Zordo T, Santner W, Amort B, Koppelstätter F, Jaschke W, Dromain C, Oberaigner W, Hubalek M, Marth C. Dual-energy contrast-enhanced spectral mammography (CESM). Arch Gynecol Obstet 2015; 292:739-47. [PMID: 25814297 DOI: 10.1007/s00404-015-3693-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
Dual-energy contrast-enhanced mammography is one of the latest developments in breast care. Imaging with contrast agents in breast cancer was already known from previous magnetic resonance imaging and computed tomography studies. However, high costs, limited availability-or high radiation dose-led to the development of contrast-enhanced spectral mammography (CESM). We reviewed the current literature, present our experience, discuss the advantages and drawbacks of CESM and look at the future of this innovative technique.
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Affiliation(s)
- Martin Daniaux
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria,
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Mohamed Kamal R, Hussien Helal M, Wessam R, Mahmoud Mansour S, Godda I, Alieldin N. Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions. Eur J Radiol 2015; 84:1049-55. [PMID: 25818731 DOI: 10.1016/j.ejrad.2015.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/13/2015] [Accepted: 03/03/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. MATERIALS AND METHOD This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. RESULTS The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. CONCLUSION The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions.
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Affiliation(s)
- Rasha Mohamed Kamal
- Radiology Department (Women's Imaging unit), Kasr ElAiny Hospital, Cairo University, Egypt
| | - Maha Hussien Helal
- Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University, Egypt
| | - Rasha Wessam
- Radiology Department (Women's Imaging unit), Kasr ElAiny Hospital, Cairo University, Egypt
| | - Sahar Mahmoud Mansour
- Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University, Egypt.
| | - Iman Godda
- Pathology Department, National Cancer Institute, Cairo University, Egypt
| | - Nelly Alieldin
- Statistics Department, National Cancer Institute, Cairo University, Egypt
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A Quantification Method for Breast Tissue Thickness and Iodine Concentration Using Photon-Counting Detector. J Digit Imaging 2015; 28:594-603. [PMID: 25708894 DOI: 10.1007/s10278-015-9784-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The purpose of contrast-enhanced digital mammography (CEDM) is to facilitate detection and characterization of the lesions in the breast using intravenous injection of an iodinated contrast agent. CEDM produces iodine images with gray levels proportional to iodine concentration at each pixel, which can be considered as quantification of iodine. While dual-energy CEDM requires an accurate knowledge of the thickness of compressed breast for the quantification, it is known that the accuracy of the built-in thickness measurement is not satisfactory. Triple-energy CEDM, which can provide a third image, can alleviate the limitation of dual-energy CEDM. If triple exposure technique is applied, it can lead to increased risk of motion artifact. An energy-resolving photon-counting detector (PCD) that can acquire multispectral X-ray images can reduce the risk of motion artifact. In this research, an easily implementable method for iodine quantification in breast imaging was suggested, and it was applied to the images of breast phantom with various iodine concentrations. The iodine concentrations in breast phantom simulate lesions filled with different iodine concentrations in the breast. The result shows that the proposed method can quantify the iodine concentrations in breast phantom accurately.
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72
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Lalji U, Lobbes M. Contrast-enhanced dual-energy mammography: a promising new imaging tool in breast cancer detection. ACTA ACUST UNITED AC 2015; 10:289-98. [PMID: 24956295 DOI: 10.2217/whe.14.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Contrast-enhanced dual-energy mammography (CEDM) is a promising new breast imaging tool for breast cancer detection. In CEDM, an iodine-based contrast agent is intravenously administered and subsequently, dual-energy mammography is performed. This results in a set of images containing both a regular mammogram and an image that contains contrast enhancement information. Preliminary studies have indicated that CEDM is superior to conventional mammography and might even match the diagnostic performance of breast MRI. In this review, the imaging technique, protocol and patient handling of CEDM is presented. Furthermore, an overview of current results on CEDM and potential future indications are outlined.
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Affiliation(s)
- Ulrich Lalji
- Maastricht University Medical Center, Department of Radiology, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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73
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Ikejimba LC, Kiarashi N, Ghate SV, Samei E, Lo JY. Task-based strategy for optimized contrast enhanced breast imaging: analysis of six imaging techniques for mammography and tomosynthesis. Med Phys 2015; 41:061908. [PMID: 24877819 DOI: 10.1118/1.4873317] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The use of contrast agents in breast imaging has the capability of enhancing nodule detectability and providing physiological information. Accordingly, there has been a growing trend toward using iodine as a contrast medium in digital mammography (DM) and digital breast tomosynthesis (DBT). Widespread use raises concerns about the best way to use iodine in DM and DBT, and thus a comparison is necessary to evaluate typical iodine-enhanced imaging methods. This study used a task-based observer model to determine the optimal imaging approach by analyzing six imaging paradigms in terms of their ability to resolve iodine at a given dose: unsubtracted mammography and tomosynthesis, temporal subtraction mammography and tomosynthesis, and dual energy subtraction mammography and tomosynthesis. METHODS Imaging performance was characterized using a detectability index d', derived from the system task transfer function (TTF), an imaging task, iodine signal difference, and the noise power spectrum (NPS). The task modeled a 10 mm diameter lesion containing iodine concentrations between 2.1 mg/cc and 8.6 mg/cc. TTF was obtained using an edge phantom, and the NPS was measured over several exposure levels, energies, and target-filter combinations. Using a structured CIRS phantom, d' was generated as a function of dose and iodine concentration. RESULTS For all iodine concentrations and dose, temporal subtraction techniques for mammography and tomosynthesis yielded the highest d', while dual energy techniques for both modalities demonstrated the next best performance. Unsubtracted imaging resulted in the lowest d' values for both modalities, with unsubtracted mammography performing the worst out of all six paradigms. CONCLUSIONS At any dose, temporal subtraction imaging provides the greatest detectability, with temporally subtracted DBT performing the highest. The authors attribute the successful performance to excellent cancellation of inplane structures and improved signal difference in the lesion.
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Affiliation(s)
- Lynda C Ikejimba
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705
| | - Nooshin Kiarashi
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 and Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27705
| | - Sujata V Ghate
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705
| | - Ehsan Samei
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705; Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27705; Department of Physics, Duke University, Durham, North Carolina 27705; and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27705
| | - Joseph Y Lo
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705; Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27705; and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27705
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74
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Lobbes MBI, Lalji UC, Nelemans PJ, Houben I, Smidt ML, Heuts E, de Vries B, Wildberger JE, Beets-Tan RG. The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer 2015; 6:144-50. [PMID: 25561979 PMCID: PMC4280397 DOI: 10.7150/jca.10705] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/14/2014] [Indexed: 11/05/2022] Open
Abstract
Background - Contrast-enhanced spectral mammography (CESM) is a promising new breast imaging modality that is superior to conventional mammography for breast cancer detection. We aimed to evaluate correlation and agreement of tumor size measurements using CESM. As additional analysis, we evaluated whether measurements using an additional breast MRI exam would yield more accurate results. Methods - Between January 1st 2013 and April 1st 2014, 87 consecutive breast cancer cases that underwent CESM were collected and data on maximum tumor size measurements were gathered. In 57 cases, tumor size measurements were also available for breast MRI. Histopathological results of the surgical specimen served as gold standard in all cases. Results - The Pearson's correlation coefficients (PCC) of CESM versus histopathology and breast MRI versus histopathology were all >0.9, p<0.0001. For the agreement between measurements, the mean difference between CESM and histopathology was 0.03 mm. The mean difference between breast MRI and histopathology was 2.12 mm. Using a 2x2 contingency table to assess the frequency distribution of a relevant size discrepancy of >1 cm between the two imaging modalities and histopathological results, we did not observe any advantage of performing an additional breast MRI after CESM in any of the cases. Conclusion - Quality of tumor size measurement using CESM is good and matches the quality of these measurement assessed by breast MRI. Additional measurements using breast MRI did not improve the quality of tumor size measurements.
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Affiliation(s)
- Marc B I Lobbes
- 1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, ; 5. GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Ulrich C Lalji
- 1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center
| | - Patty J Nelemans
- 2. Department of Epidemiology, Maastricht, the Netherlands, Maastricht, the Netherlands; Maastricht University
| | - Ivo Houben
- 1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center
| | - Marjolein L Smidt
- 3. Department of Surgical Oncology, Maastricht University Medical Center; ; 5. GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Esther Heuts
- 3. Department of Surgical Oncology, Maastricht University Medical Center
| | - Bart de Vries
- 4. Department of Pathology, Maastricht University Medical Center
| | - Joachim E Wildberger
- 1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, ; 5. GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Regina G Beets-Tan
- 1. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, ; 5. GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Alcantara D, Leal MP, García-Bocanegra I, García-Martín ML. Molecular imaging of breast cancer: present and future directions. Front Chem 2014; 2:112. [PMID: 25566530 PMCID: PMC4270251 DOI: 10.3389/fchem.2014.00112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/01/2014] [Indexed: 12/21/2022] Open
Abstract
Medical imaging technologies have undergone explosive growth over the past few decades and now play a central role in clinical oncology. But the truly transformative power of imaging in the clinical management of cancer patients lies ahead. Today, imaging is at a crossroads, with molecularly targeted imaging agents expected to broadly expand the capabilities of conventional anatomical imaging methods. Molecular imaging will allow clinicians to not only see where a tumor is located in the body, but also to visualize the expression and activity of specific molecules (e.g., proteases and protein kinases) and biological processes (e.g., apoptosis, angiogenesis, and metastasis) that influence tumor behavior and/or response to therapy. Breast cancer, the most common cancer among women and a research area where our group is actively involved, is a very heterogeneous disease with diverse patterns of development and response to treatment. Hence, molecular imaging is expected to have a major impact on this type of cancer, leading to important improvements in diagnosis, individualized treatment, and drug development, as well as our understanding of how breast cancer arises.
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Affiliation(s)
- David Alcantara
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Manuel Pernia Leal
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Irene García-Bocanegra
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Maria L García-Martín
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
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76
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Hwang YS, Lin YY, Cheung YC, Tsai HY. Three-dimensional dose distribution in contrast-enhanced digital mammography using Gafchromic XR-QA2 films: Feasibility study. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blum KS, Rubbert C, Mathys B, Antoch G, Mohrmann S, Obenauer S. Use of contrast-enhanced spectral mammography for intramammary cancer staging: preliminary results. Acad Radiol 2014; 21:1363-9. [PMID: 25127846 DOI: 10.1016/j.acra.2014.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To prospectively evaluate and compare the accuracy of contrast-enhanced spectral mammography (CESM) and ultrasound (US) in size measurement of breast cancer with histologic tumor sizes as gold standard. MATERIALS AND METHODS Twenty women aged between 40-73 years (mean age, 57 ± 10 years) with histologically proven invasive ductal/lobular carcinomas were included in the study. Agreement between imaging tumor size (CESM and US) and histopathologic tumor size was evaluated with Bland-Altman analysis. Stereotactically guided vacuum biopsy was performed in four patients after CESM. Two independent reviewers described artifacts of CESM. RESULTS Motion artifacts did not occur in the study. CESM-specific artifacts caused by scattered radiation mostly occurred in oblique view of CESM. Background enhancement of breast tissue was seen in four patients. Mean difference of tumor sizes was 0.3 mm (6.34%) between CESM and histology and -2.2 mm (-7.59%) between US and histology. Limits of agreement ranged from -18.9 to 19.48 mm for CESM and from -17.1 to 12.7 mm with US. Especially smaller tumors with a size <23 mm were measured more precisely with CESM. Enhancement of breast tissue around microcalcifications correlated with abnormalities. CONCLUSIONS CESM is accurate in size measurements of small breast tumors. On average CESM leads to a slight overestimation of tumor size, whereas US tends to underestimate tumor size. Assessment of the breast tissue can be limited by the scattered radiation artifact and background enhancement of breast tissue. CESM seems to be helpful in the characterization of breast tissue around microcalcifications.
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Mamografía con realce de contraste mediante técnica de energía dual. RADIOLOGIA 2014; 56:390-9. [DOI: 10.1016/j.rx.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/01/2014] [Accepted: 05/12/2014] [Indexed: 02/03/2023]
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Can contrast enhanced mammography solve the problem of dense breast lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Despite controversy regarding mammography's efficacy, it continues to be the most commonly used breast cancer-screening modality. With the development of digital mammography, some improved benefit has been shown in women with dense breast tissue. However, the density of breast tissue continues to limit the sensitivity of conventional mammography. We discuss the development of some derivative digital technologies, primarily digital breast tomosynthesis, and their strengths, weaknesses, and potential patient impact.
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Affiliation(s)
- Stephanie K Patterson
- Division of Breast Imaging, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Marilyn A Roubidoux
- Division of Breast Imaging, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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Lobbes MBI, Lalji U, Houwers J, Nijssen EC, Nelemans PJ, van Roozendaal L, Smidt ML, Heuts E, Wildberger JE. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol 2014; 24:1668-76. [PMID: 24696228 DOI: 10.1007/s00330-014-3154-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/03/2014] [Accepted: 03/17/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM. METHODS During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities. RESULTS Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0% (+3.1%), specificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) and NPV to 100.0% (+2.9%) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed. CONCLUSION CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening. KEY POINTS • CESM is feasible in the workflow of referrals from routine breast screening. • CESM is superior to mammography, even in low disease prevalence populations. • CESM has an extremely high negative predictive value for breast cancer. • CESM is comparable to MRI in assessment of breast cancer extent. • CESM is comparable to histopathology in assessment of breast cancer extent.
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Affiliation(s)
- Marc B I Lobbes
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
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Abstract
Mammography is the only technology documented to reduce breast cancer mortality. Its sensitivity, however, is 75% to 80% at best and reduced to 30% to 50% in women with dense breasts. MR imaging is a sensitive modality for the detection of breast cancer but cannot be used in all patients. Its sensitivity is due in large part to its ability to detect enhancement of tumor vascularity so cancers can be detected before a mass is present. Contrast-enhanced dual-energy mammography uses the same capability of vascular enhancement and has been demonstrated to be more sensitive than routine mammography.
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Affiliation(s)
- Maxine Jochelson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, 300 East 66th Street #711, New York, NY 10065, USA.
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84
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Badr S, Laurent N, Régis C, Boulanger L, Lemaille S, Poncelet E. Dual-energy contrast-enhanced digital mammography in routine clinical practice in 2013. Diagn Interv Imaging 2013; 95:245-58. [PMID: 24238816 DOI: 10.1016/j.diii.2013.10.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To date, analysis of the vascularisation of breast lesions mainly relies on MR imaging. However, the accessibility of MRI is sometimes limited and has led to the development of new means of imaging, such as dual-energy contrast-enhanced mammography, which provides data on the vascularisation of the breast along with the usual morphological information. The purpose of this paper is to present this new imaging technique as well as the recent references, illustrated by clinical reports derived from our everyday practice to focus on the advantages and disadvantages of this new breast exploration. Dual-energy contrast-enhanced mammography is a recent, seemingly promising technique, in the management of breast cancer. The main advantages consist of its easy installation, the good tolerance and the comfort in the interpretation of difficult to read mammograms. However, the indications and the role of dual-energy contrast-enhanced mammography still have to be determined within the diagnostic strategy of breast tumours. New studies are expected, especially to compare dual-energy contrast-enhanced mammography with breast MRI.
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Affiliation(s)
- S Badr
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France; Centre Hospitalier Régional Universitaire de Lille, service d'imagerie de la femme, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - N Laurent
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France; Centre Hospitalier de Valenciennes, service d'imagerie de la femme, avenue Désandrouin, 59300 Valenciennes, France; Centre Hospitalier Régional Universitaire de Lille, service d'imagerie de la femme, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - C Régis
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France
| | - L Boulanger
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France; Centre Hospitalier Régional Universitaire de Lille, service d'imagerie de la femme, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - S Lemaille
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France
| | - E Poncelet
- Centre Hospitalier d'Armentières, Centre d'imagerie de la femme, 112, rue Sadi-Carnot, 59280 Armentières, France; Centre Hospitalier de Valenciennes, service d'imagerie de la femme, avenue Désandrouin, 59300 Valenciennes, France; Centre Hospitalier Régional Universitaire de Lille, service d'imagerie de la femme, 2, avenue Oscar-Lambret, 59000 Lille, France
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85
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Fallenberg EM, Dromain C, Diekmann F, Engelken F, Krohn M, Singh JM, Ingold-Heppner B, Winzer KJ, Bick U, Renz DM. Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol 2013; 24:256-64. [PMID: 24048724 DOI: 10.1007/s00330-013-3007-7] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/04/2013] [Accepted: 07/25/2013] [Indexed: 11/27/2022]
Affiliation(s)
- E M Fallenberg
- Clinic of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany,
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86
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Contrast enhanced mammography: Techniques, current results, and potential indications. Clin Radiol 2013; 68:935-44. [DOI: 10.1016/j.crad.2013.04.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/30/2013] [Accepted: 04/23/2013] [Indexed: 02/03/2023]
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87
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Leithner R, Knogler T, Homolka P. Development and production of a prototype iodine contrast phantom for CEDEM. Phys Med Biol 2013; 58:N25-35. [PMID: 23322073 DOI: 10.1088/0031-9155/58/3/n25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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88
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Correlation of contrast agent kinetics between iodinated contrast-enhanced spectral tomosynthesis and gadolinium-enhanced MRI of breast lesions. Eur Radiol 2013; 23:1528-36. [DOI: 10.1007/s00330-012-2742-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/06/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
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89
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Abstract
O câncer de mama é um dos mais prevalentes nas mulheres. A mamografia é um excelente método com impacto comprovado na redução da mortalidade pelo câncer de mama. Porém, não é um método perfeito, apresentando alguns pontos fracos, principalmente no rastreamento de mulheres com mamas densas, estadiamento e avaliação de tratamento. A ressonância magnética mamária mostrou a necessidade e importância da avaliação funcional mamária. Descrevemos dois métodos de avaliação funcional mamária e demonstramos nossa experiência com a mamografia digital com contraste e com a imagem molecular mamária realizada em gama-câmara específica. Estes dois métodos já estão disponíveis em nosso meio e apresentam resultados promissores na detecção de lesões mamográficas ocultas, confirmação de lesões suspeitas e redução de biópsias desnecessárias, podendo assim melhorar o estudo mamário, principalmente nos pontos falhos da mamografia.
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90
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Allec N, Abbaszadeh S, Scott CC, Lewin JM, Karim KS. Including the effect of motion artifacts in noise and performance analysis of dual-energy contrast-enhanced mammography. Phys Med Biol 2012. [DOI: 10.1088/0031-9155/57/24/8405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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91
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Heijblom M, Klaase JM, van den Engh FM, van Leeuwen TG, Steenbergen W, Manohar S. Imaging Tumor Vascularization for Detection and Diagnosis of Breast Cancer. Technol Cancer Res Treat 2011; 10:607-23. [DOI: 10.7785/tcrt.2012.500227] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- M. Heijblom
- Biomedical Photonic Imaging Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
- Center for Breast Care, Medisch Spectrum Twente Hospital, P.O. Box 50000, 7500 KA Enschede, the Netherlands
| | - J. M. Klaase
- Center for Breast Care, Medisch Spectrum Twente Hospital, P.O. Box 50000, 7500 KA Enschede, the Netherlands
| | - F. M. van den Engh
- Center for Breast Care, Medisch Spectrum Twente Hospital, P.O. Box 50000, 7500 KA Enschede, the Netherlands
| | - T. G. van Leeuwen
- Biomedical Photonic Imaging Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, P.O. Box 2270, 1100 DE Amsterdam, the Netherlands
| | - W. Steenbergen
- Biomedical Photonic Imaging Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - S. Manohar
- Biomedical Photonic Imaging Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
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92
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Abstract
The sensitivity of screening mammography is limited in the evaluation of dense breasts, with as few as 45% of cancers visible in extremely dense breasts. Supplementary imaging for improved sensitivity in women with dense breasts is necessary to overcome this limitation. Emerging technologies that advance the applications of digital mammography include digital breast tomosynthesis and dedicated breast cone-beam computed tomography. Molecular imaging goes beyond structural imaging. A functional imaging technique that provides information on the biology, physiology, and metabolic pathways of cancer might help to improve the sensitivity and specificity of breast cancer diagnosis, facilitate early assessment of treatment response, and help individualize therapy options for patients. Advanced magnetic resonance, nuclear medicine, and optical imaging techniques in the realm of molecular imaging will be explored in this article.
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Affiliation(s)
- Wei Tse Yang
- Breast Imaging Section, Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
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93
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Allec N, Abbaszadeh S, Karim KS. Single-layer and dual-layer contrast-enhanced mammography using amorphous selenium flat panel detectors. Phys Med Biol 2011; 56:5903-23. [DOI: 10.1088/0031-9155/56/18/009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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94
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Aibar L, Santalla A, Criado ML, González–Pérez I, Calderón M, Gallo J, -Parra JF. Clasificación radiológica y manejo de las lesiones mamarias. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2010.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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95
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Sree SV, Ng EYK, Acharya RU, Faust O. Breast imaging: A survey. World J Clin Oncol 2011; 2:171-8. [PMID: 21611093 PMCID: PMC3100484 DOI: 10.5306/wjco.v2.i4.171] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 01/07/2011] [Accepted: 01/14/2011] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the second leading cause of death in women. It occurs when cells in the breast start to grow out of proportion and invade neighboring tissues or spread throughout the body. Mammography is one of the most effective and popular modalities presently used for breast cancer screening and detection. Efforts have been made to improve the accuracy of breast cancer diagnosis using different imaging modalities. Ultrasound and magnetic resonance imaging have been used to detect breast cancers in high risk patients. Recently, electrical impedance imaging and nuclear medicine techniques are also being widely used for breast cancer screening and diagnosis. In this paper, we discuss the capabilities of various breast imaging modalities.
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Affiliation(s)
- Subbhuraam Vinitha Sree
- Subbhuraam Vinitha Sree, Eddie Yin-Kwee Ng, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
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96
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Schmitzberger FF, Fallenberg EM, Lawaczeck R, Hemmendorff M, Moa E, Danielsson M, Bick U, Diekmann S, Pöllinger A, Engelken FJ, Diekmann F. Development of low-dose photon-counting contrast-enhanced tomosynthesis with spectral imaging. Radiology 2011; 259:558-64. [PMID: 21330558 DOI: 10.1148/radiol.11101682] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To demonstrate the feasibility of low-dose photon-counting tomosynthesis in combination with a contrast agent (contrast material-enhanced tomographic mammography) for the differentiation of breast cancer. MATERIALS AND METHODS All studies were approved by the institutional review board, and all patients provided written informed consent. A phantom model with wells of iodinated contrast material (3 mg of iodine per milliliter) 1, 2, 5, 10, and 15 mm in diameter was assessed. Nine patients with malignant lesions and one with a high-risk lesion (atypical papilloma) were included (all women; mean age, 60.7 years). A multislit photon-counting tomosynthesis system was utilized (spectral imaging) to produce both low- and high-energy tomographic data (below and above the k edge of iodine, respectively) in a single scan, which allowed for dual-energy visualization of iodine. Images were obtained prior to contrast material administration and 120 and 480 seconds after contrast material administration. Four readers independently assessed the images along with conventional mammograms, ultrasonographic images, and magnetic resonance images. Glandular dose was estimated. RESULTS Contrast agent was visible in the phantom model with simulated spherical tumor diameters as small as 5 mm. The average glandular dose was measured as 0.42 mGy per complete spectral imaging tomosynthesis scan of one breast. Because there were three time points (prior to contrast medium administration and 120 and 480 seconds after contrast medium administration), this resulted in a total dose of 1.26 mGy for the whole procedure in the breast with the abnormality. Seven of 10 cases were categorized as Breast Imaging Reporting and Data System score of 4 or higher by all four readers when reviewing spectral images in combination with mammograms. One lesion near the chest wall was not captured on the spectral image because of a positioning problem. CONCLUSION The use of contrast-enhanced tomographic mammography has been demonstrated successfully in patients with promising diagnostic benefit. Further studies are necessary to fully assess diagnostic sensitivity and specificity.
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Affiliation(s)
- Florian F Schmitzberger
- Department of Radiology, Charité University of Medicine, Charitéplatz 1, 10117 Berlin, Germany
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97
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Kruger RA, Lam RB, Reinecke DR, Del Rio SP, Doyle RP. Photoacoustic angiography of the breast. Med Phys 2011; 37:6096-100. [PMID: 21158321 DOI: 10.1118/1.3497677] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The authors report a noninvasive technique and instrumentation for visualizing vasculature in the breast in three dimensions without using either ionizing radiation or exogenous contrast agents, such as iodine or gadolinium. Vasculature is visualized by virtue of its high hemoglobin content compared to surrounding breast parenchyma. The technique is compatible with dynamic contrast-enhanced studies. METHODS Photoacoustic sonic waves were stimulated in the breast with a pulsed laser operating at 800 nm and a mean exposure of 20 mJ/pulse over an area of approximately 20 cm2. These waves were subsequently detected by a hemispherical array of piezoelectric transducers, the temporal signals from which were filtered and backprojected to form three-dimensional images with nearly uniform k-space sampling. RESULTS Three-dimensional vascular images of a human volunteer demonstrated a clear visualization of vascular anatomy with submillimeter spatial resolution to a maximum depth of 40 mm using a 24 s image acquisition protocol. Spatial resolution was nearly isotropic and approached 250 microm over a 64 x 64 x 50 mm field of view. CONCLUSIONS The authors have successfully visualized submillimeter breast vasculature to a depth of 40 mm using an illumination intensity that is 32 times less than the maximum permissible exposure according to the American National Standard for Safe Use of Lasers. Clearly, the authors can achieve greater penetration depth in the breast by increasing the intensity and the cross-sectional area of the illumination beam. Given the 24 s image acquisition time without contrast agent, dynamic, contrast-enhanced, photoacoustic breast imaging using optically absorbing contrast agents is conceivable in the future.
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Affiliation(s)
- Robert A Kruger
- OptoSonics, Inc., 108 Straight Road, Oriental, North Carolina 28571, USA.
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98
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Helvie MA. Digital mammography imaging: breast tomosynthesis and advanced applications. Radiol Clin North Am 2010; 48:917-29. [PMID: 20868894 DOI: 10.1016/j.rcl.2010.06.009] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article discusses recent developments in advanced derivative technologies associated with digital mammography. Digital breast tomosynthesis, its principles, development, and early clinical trials, are reviewed. Contrast-enhanced digital mammography and combined imaging systems with digital mammography and ultrasound are also discussed. Although all these methods are currently research programs, they hold promise for improving cancer detection and characterization if early results are confirmed by clinical trials.
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Affiliation(s)
- Mark A Helvie
- Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, SPC 5326, Ann Arbor, MI 48109, USA.
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Thibault F, Malhaire C, Athanasiou A, Ollivier L, Tardivon A, El Khoury C. Tomosynthèse : principe et applications. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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