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Azam S, Tamimi RM, Drotman MB, Babagbemi K, Levy AD, Peña JM. Assessing breast arterial calcification in mammograms and its implications for atherosclerotic cardiovascular disease risk. Clin Imaging 2024; 109:110129. [PMID: 38582071 DOI: 10.1016/j.clinimag.2024.110129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Breast arterial calcifications (BAC) are incidentally observed on mammograms, yet their implications remain unclear. We investigated lifestyle, reproductive, and cardiovascular determinants of BAC in women undergoing mammography screening. Further, we investigated the relationship between BAC, coronary arterial calcifications (CAC) and estimated 10-year atherosclerotic cardiovascular (ASCVD) risk. METHODS In this cross-sectional study, we obtained reproductive history and CVD risk factors from 215 women aged 18 or older who underwent mammography and cardiac computed tomographic angiography (CCTA) within a 2-year period between 2007 and 2017 at hospital. BAC was categorized as binary (present/absent) and semi-quantitatively (mild, moderate, severe). CAC was determined using the Agatston method and recorded as binary (present/absent). Adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, accounting for age as a confounding factor. ASCVD risk over a 10-year period was calculated using the Pooled Cohort Risk Equations. RESULTS Older age, systolic and diastolic blood pressures, higher parity, and younger age at first birth (≤28 years) were significantly associated with greater odds of BAC. Women with both BAC and CAC had the highest estimated 10-year risk of ASCVD (13.30 %). Those with only BAC (8.80 %), only CAC (5.80 %), and no BAC or CAC (4.40 %) had lower estimated 10-year risks of ASCVD. No association was detected between presence of BAC and CAC. CONCLUSIONS These findings support the hypothesis that BAC on a screening mammogram may help to identify women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.
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Affiliation(s)
- Shadi Azam
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | - Michele B Drotman
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, USA.
| | - Kemi Babagbemi
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, USA.
| | - Allison D Levy
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, USA.
| | - Jessica M Peña
- Departments of Medicine and Radiology, Weill Cornell Medicine, New York, USA.
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2
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Vincoff NS, Ramos AA, Duran-Pilarte E, Derobertis A, Daniel W, Bajwa BN, Petrone E, Kline M, Pavel DM, Rosen SE. Patient Notification About Breast Arterial Calcification on Mammography: Empowering Women With Information About Cardiovascular Risk. JOURNAL OF BREAST IMAGING 2023; 5:658-665. [PMID: 38141233 DOI: 10.1093/jbi/wbad063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation. METHODS This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions. RESULTS Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography. CONCLUSION After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.
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Affiliation(s)
- Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Aderonke A Ramos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | | | - Alicia Derobertis
- New-York Presbyterian Healthcare System Inc, Department of Radiology, New York, NY, USA
| | - Woodlynn Daniel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Bakhtawar N Bajwa
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Eric Petrone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Myriam Kline
- Northwell Health Feinstein Institutes for Medical Research, Department of Statistics, Manhasset, NY, USA
| | - Donatella M Pavel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Stacey E Rosen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Cardiology, Manhasset, NY, USA
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3
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Roshan MP, Cury RC, Lampen-Sachar K. Assessing cardiovascular risk with mammography and non-contrast chest CT: A review of the literature and clinical implications. Clin Imaging 2023; 103:109983. [PMID: 37716018 DOI: 10.1016/j.clinimag.2023.109983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of mortality and disability globally. In the United States, about 7.2% of adults aged 20 and older are affected by CAD. However, due to its progression over decades, CAD is often undetected and unnoticed until plaque ruptures. This leads to partial or complete artery blockage, resulting in myocardial infarction. Thus, new screening methods for early detection of CAD are needed to prevent and minimize the morbidity and mortality from CAD. Vascular calcifications seen on mammography and non-contrast chest CT (NCCT) can be used for the early detection of CAD and are an accurate predictor of cardiovascular risk. This paper aims to review the basic epidemiology, pathophysiology, imaging findings, and correlation of long-term cardiovascular outcomes with vascular calcifications on mammography and NCCT.
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Affiliation(s)
- Mona P Roshan
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA
| | - Ricardo C Cury
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA; Baptist Health of South Florida and Radiology Associates of South Florida, Miami, FL 33176, USA
| | - Katharine Lampen-Sachar
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA; Baptist Health of South Florida and Radiology Associates of South Florida, Miami, FL 33176, USA.
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4
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Canan A, Ghandour AAH, Saboo SS, Rajiah PS. Opportunistic screening at chest computed tomography: literature review of cardiovascular significance of incidental findings. Cardiovasc Diagn Ther 2023; 13:743-761. [PMID: 37675086 PMCID: PMC10478026 DOI: 10.21037/cdt-23-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023]
Abstract
Background and Objective Several incidental cardiovascular findings are present in a routine chest computed tomography (CT) scan, many of which do not make it to the final radiology report. However, these findings have important clinical implications, particularly providing prognosis and risk-stratification for future cardiovascular events. The purpose of this article is to review the literature on these incidental cardiovascular findings in a routine chest CT and inform the radiologist on their clinical relevance. Methods A time unlimited review of PubMed and Web of Science was performed by using relevant keywords. Articles in English that involved adults were included. Key Content and Findings Coronary artery calcification (CAC) is the most common incidental cardiac finding detected in a routine chest CT and is a significant predictor of cardiovascular events. Noncoronary vascular calcifications in chest CT include aortic valve, mitral annulus, and thoracic aortic calcifications (TAC). Among these, aortic valve calcification (AVC) has the strongest association with coronary artery disease and cardiovascular events. Additional cardiac findings such as myocardial scar and left ventricular size and noncardiac findings such as thoracic fat, bone density, hepatic steatosis, and breast artery calcifications can also help in risk stratification and patient management. Conclusions The radiologist interpreting a routine chest CT should be cognizant of the incidental cardiovascular findings, which helps in the diagnosis and risk-stratification of cardiovascular disease. This will guide appropriate referral and management.
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Affiliation(s)
- Arzu Canan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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5
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Leong DP, Cirne F, Aghel N, Baro Vila RC, Cavalli GD, Ellis PM, Healey JS, Whitlock R, Khalaf D, Mian H, Jolly SS, Mehta SR, Dent S. Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:415-430. [PMID: 37614581 PMCID: PMC10443114 DOI: 10.1016/j.jaccao.2023.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 08/25/2023] Open
Abstract
Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Filipe Cirne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nazanin Aghel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peter M. Ellis
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S. Healey
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dina Khalaf
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shamir R. Mehta
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
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6
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Ibrahim M, Suleiman ME, Gandomkar Z, Tavakoli Taba A, Arnott C, Jorm L, Barraclough JY, Barbieri S, Brennan PC. Associations of Breast Arterial Calcifications with Cardiovascular Disease. J Womens Health (Larchmt) 2023; 32:529-545. [PMID: 36930147 DOI: 10.1089/jwh.2022.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Cardiovascular diseases (CVD), including coronary artery disease (CAD), continue to be the leading cause of global mortality among women. While traditional CVD/CAD prevention tools play a significant role in reducing morbidity and mortality among both men and women, current tools for preventing CVD/CAD rely on traditional risk factor-based algorithms that often underestimate CVD/CAD risk in women compared with men. In recent years, some studies have suggested that breast arterial calcifications (BAC), which are benign calcifications seen in mammograms, may be linked to CVD/CAD. Considering that millions of women older than 40 years undergo annual screening mammography for breast cancer as a regular activity, innovative risk prediction factors for CVD/CAD involving mammographic data could offer a gender-specific and convenient solution. Such factors that may be independent of, or complementary to, current risk models without extra cost or radiation exposure are worthy of detailed investigation. This review aims to discuss relevant studies examining the association between BAC and CVD/CAD and highlights some of the issues related to previous studies' design such as sample size, population types, method of assessing BAC and CVD/CAD, definition of cardiovascular events, and other confounding factors. The work may also offer insights for future CVD risk prediction research directions using routine mammograms and radiomic features other than BAC such as breast density and macrocalcifications.
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Affiliation(s)
- Mu'ath Ibrahim
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ziba Gandomkar
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Amir Tavakoli Taba
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Clare Arnott
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Louisa Jorm
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Jennifer Y Barraclough
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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7
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Shobeiri E, Rai A, Rouzbahani M, Heidari Moghadam R, Azimivghar J, Pourmirza F, Tadbiri H, Salehi N. Assessing the Stress Echocardiography in Women With Breast Arterial Calcification. J Family Reprod Health 2021; 15:196-201. [PMID: 34721611 PMCID: PMC8536829 DOI: 10.18502/jfrh.v15i3.7138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p<0.001). The prevalence rates of the diabetes mellitus, hypertension, hypercholesterolemia, and history of CVDs were significantly higher in the patients who were positive for MI. Conclusion: It was found that BACs are correlated with an increased occurrence rate of CVDs. Our results illustrated that the patients who were positive for MI were more plausible to be diabetic, hyperlipidemic, hypertensive, and having a history of CVDs.
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Affiliation(s)
- Elham Shobeiri
- Department of Radiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Rai
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Heidari Moghadam
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Azimivghar
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faranak Pourmirza
- Department of Radiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Tadbiri
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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8
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Margolies L, Chaudhry S. Pushing anxiety as a risk of screening mammography is benevolent sexism and bad for women's health outcomes. Clin Imaging 2020; 68:166-168. [PMID: 32645603 DOI: 10.1016/j.clinimag.2020.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/10/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
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9
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Bochkareva EV, Kim IV, Butina EK, Stulin ID, Trukhanov SA, Rudenko BA, Boytsov SA, Drapkina OM. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 2. Association of Breast Arterial Calcification and Cardiovascular Diseases. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-3-424-430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prospects for the use of mammographic detection of breast arterial calcification (BAC) to improve the stratification of cardiovascular risk in the female population are of increasing interest. The purpose of the 2 part of the review is the analysis of modern literature on the relationship of the BAC with the prevalence and mortality from cardiovascular diseases (CVD). The presence of BAC on mammograms is associated with a higher likelihood of myocardial infarction, death from coronary heart disease (CHD) and CVD, as well as a 3.5-fold increase in the risk of CHD and a 5-year coronary incident (p=0.003). Women with BAC have a higher likelihood of coronary artery disease detected during angiography than women without BAC (p<0.001). Severe BAC has a stronger association with CVD than mild calcification. The association of BAC with cerebrovascular diseases and a 1.4-fold increase in the risk of ischemic stroke (p=0.004), atheromatosis of the carotid arteries and an increase in the thickness of the intima-media complex is shown. BAC is associated with atherosclerotic lesions of peripheral arteries and a decrease in the ankle-brachial index <0.9 (p=0.048). In women with chronic kidney disease, the presence of BAC indicates a 4.5-fold increase in the risk of complications associated with impaired blood flow in peripheral arteries. It is shown that the addition of BAC to the generally accepted (standard) vascular risk assessment algorithms Framingham Risk Score and Pooled Cohort Equation significantly increases the accuracy of prediction of CHD (p=0.02 and p=0.010, respectively). The detection of BAC on mammographic screening is a new promising direction for cardiovascular prophylaxis in women and opens up new opportunities for identifying groups of people with subclinical forms of CVD and high cardiovascular risk.
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Affiliation(s)
| | - I. V. Kim
- National Medical Research Center for Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Preventive Medicine
| | - I. D. Stulin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - S. A. Trukhanov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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10
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Peña JM. Thinking Outside the Heart. JACC Cardiovasc Imaging 2019; 12:1212-1214. [DOI: 10.1016/j.jcmg.2018.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
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11
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Bochkareva EV, Kim IV, Butina EK, Stulin ID, Trukhanov SA, Rudenko BA, Boytsov SA, Drapkina OM. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-2-244-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - I. V. Kim
- National Medical Research Center for Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Preventive Medicine
| | - I. D. Stulin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - S. A. Trukhanov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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12
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Convolutional Neural Networks for the Segmentation of Microcalcification in Mammography Imaging. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:9360941. [PMID: 31093321 PMCID: PMC6481152 DOI: 10.1155/2019/9360941] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
Cluster of microcalcifications can be an early sign of breast cancer. In this paper, we propose a novel approach based on convolutional neural networks for the detection and segmentation of microcalcification clusters. In this work, we used 283 mammograms to train and validate our model, obtaining an accuracy of 99.99% on microcalcification detection and a false positive rate of 0.005%. Our results show how deep learning could be an effective tool to effectively support radiologists during mammograms examination.
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13
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McLenachan S, Camilleri F, Smith M, Newby DE, Williams MC. Breast arterial calcification on mammography and risk of coronary artery disease: a SCOT-HEART sub-study. Clin Radiol 2019; 74:421-428. [PMID: 30803814 PMCID: PMC6512949 DOI: 10.1016/j.crad.2019.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/22/2019] [Indexed: 01/28/2023]
Abstract
AIM To assess the prevalence of breast arterial calcification (BAC) in patients who also underwent routine surveillance mammography, and to determine the association with cardiovascular risk factors, coronary artery calcification, and coronary artery disease on coronary computed tomography angiography (CCTA). MATERIALS AND METHODS Four hundred and five female participants were identified who had undergone CCTA and subsequent mammography in the SCOT-HEART randomised controlled trial of CCTA in patients with suspected stable angina. Mammograms were assessed visually for the presence and severity of BAC. RESULTS BAC was identified in 93 (23%) patients. Patients with BAC were slightly older (63±7 versus 59±8 years, p<0.001), with a higher cardiovascular risk score (19±11 versus 16±10, p=0.022) and were more likely to be non-smokers (73% versus 49%, p<0.001). In patients with BAC, coronary artery calcification was present in 58 patients (62%; relative risk [RR] 1.26, 95% confidence intervals [CI]: 1.04, 1.53; p=0.02), non-obstructive coronary artery disease in 58 (62%; RR 1.27, 95% CI: 1.04 to 1.54, p=0.02), and obstructive coronary artery disease in 19 (20%; RR 1.62, 95% CI: 0.98, 2.66; p=0.058). Patients without BAC were very unlikely to have severe coronary artery calcification (negative predictive value 95%) but the diagnostic accuracy of BAC to identify coronary artery disease was poor (AUC 0.547). CONCLUSION Although BAC is associated with the presence and severity of coronary artery calcification, the diagnostic accuracy to identify patients with coronary artery disease or obstructive coronary artery disease is poor. Breast arterial calcification occurs in a fifth of patients referred for CCTA who tend to be older non-smokers. It is associated with higher coronary artery calcium but this is predominantly dependent on age and cardiovascular risks. Absence of breast arterial calcification excludes severe coronary artery calcification, negative predictive value of 95%.
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Affiliation(s)
- S McLenachan
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - F Camilleri
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Smith
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - D E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - M C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
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14
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Suh JW, Yun BL. Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease. J Cardiovasc Imaging 2018; 26:125-134. [PMID: 30310879 PMCID: PMC6160812 DOI: 10.4250/jcvi.2018.26.e20] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Breast arterial calcifications (BAC), frequently observed on screening mammography, have been considered as an incidental finding without increased risk for breast cancer. They are medial calcifications and therefore, are indicative of arteriosclerosis. Previous studies indicated that the risk factors of BAC partly overlap with those of cardiovascular disease (CVD), and the presence of BAC is associated with prevalent and incident CVD. This suggests that medial arterial calcification might contribute to CVD through a pathway distinct from the intimal atherosclerotic process. A recent study showed that the presence and severity of BAC are associated with the presence of coronary artery calcification or plaques on coronary computed tomography angiography in asymptomatic women aged more than 40 years. In addition, BAC provided an independent and incremental predictive value over conventional risk factors. Given that population-based mammography screening is currently recommended in asymptomatic women, the evaluation of BAC may be helpful in identifying high-risk women without additional cost or radiation exposure.
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Affiliation(s)
- Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seongnam, Korea
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15
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Iribarren C, Sanchez G, Husson G, Levine-Hall T, Quesenberry C, Sam DL, Maier J, Chaudhary RS, Patel M, Sadeghi B, Javan H, Cho HM, Ding H, Molloi S. MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics. Ann Epidemiol 2018; 28:41-47.e12. [DOI: 10.1016/j.annepidem.2017.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 12/18/2022]
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16
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Ryan AJ, Choi AD, Choi BG, Lewis JF. Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women. Clin Cardiol 2017; 40:648-653. [PMID: 28444996 DOI: 10.1002/clc.22702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/19/2022] Open
Abstract
Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.
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Affiliation(s)
- Angela J Ryan
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Brian G Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Jannet F Lewis
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
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