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Hua B, Yang G, Wang Y, Chen J, Rong X, Yuan T, Quan G. Diagnostic performance of the Kaiser score for contrast-enhanced mammography and magnetic resonance imaging in breast masses: A Comparative Study. Acad Radiol 2024:S1076-6332(24)00701-3. [PMID: 39395886 DOI: 10.1016/j.acra.2024.09.054] [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: 03/09/2024] [Revised: 09/24/2024] [Accepted: 09/24/2024] [Indexed: 10/14/2024]
Abstract
RATIONALE AND OBJECTIVES The Kaiser score (KS) is a simple and intuitive machine-learning derived decision rule for characterizing breast lesions in a clinical setting and screening for breast cancer. The present study aims to investigate the applicability of the KS for contrast-enhanced mammography (CEM) in breast masses, and to compare its diagnostic accuracy with magnetic resonance imaging (MRI). CEM may provide an alternative option for patients with breast masses, especially for those with MRI contraindications. MATERIALS AND METHODS Two hundred and seventy-five patients with breast enhanced masses were included in the study from May 2019 to September 2022. Patients were further divided into benign and malignant groups based on pathological diagnosis. The CEM and MRI imaging characteristics of these two groups were analyzed statistically. The paired chi-square and Cohen's kappa coefficient (κ) analysis were used to compare imaging characteristics between CEM and MRI. The Breast Imaging Reporting and Data System (BI-RADS) and KS for CEM and MRI were evaluated based on imaging characteristics. The diagnostic performance of BI-RADS and KS for CEM and MRI was assessed and compared using receiver operating characteristic (ROC) analysis and DeLong's test. RESULTS The imaging characteristics of root sign, time-signal intensity curve (TIC/mTIC), margin, internal enhancement pattern (IEP), edema, apparent diffusion coefficient (ADC) values, and suspicious malignant microcalcifications showed significant differences between benign and malignant lesions (all p ≤ 0.011). The detection rate of root sign and margin showed substantial agreement between CEM and MRI (κ = 0.656, κ = 0.640), but IEP, TIC/mTIC, and edema showed poor agreement (κ = 0.380, κ = 0.320, κ = 0.324). For all lesion analyses, the area under the curves (AUCs) of the KS (0.897 ∼ 0.932) were higher than that of BI-RADS (0.691) in CEM (all p < 0.001). The AUC of KS (calcification)-CEM (0.932) was higher than those of both KS-CEM and KS (edema)-CEM (0.897 and 0.899) (all p < 0.001). For subgroup analyses, the AUCs of the KS (0.875 ∼ 0.876) were higher than that of BI-RADS (0.740) in MRI (all p < 0.001). The AUCs of KS-MRI (0.876) and KS (ADC)-MRI (0.875) were similar to those of KS-CEM (0.878) and KS (edema)-CEM (0.870) (all p > 0.100). The AUC of KS (calcification)-CEM (0.934) was slightly higher than those of both KS-MRI (0.876) and KS (ADC)-MRI (0.875), but no significant difference was observed (p = 0.051; p = 0.071). CONCLUSION The KS for CEM provided high diagnostic accuracy in distinguishing breast masses, comparable to that of MRI. The application of KS (calcification)-CEM combined with suspicious malignant microcalcifications can improve diagnostic efficiency with an AUC of 0.932 ∼ 0.934. However, edema did not significantly improve performance when using the KS for CEM.
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Affiliation(s)
- Bei Hua
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No.89 Donggang road, Shijiazhuang, Hebei, China (B.H., Y.W.)
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China (G.Y., J.C., X.R.)
| | - Yong Wang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No.89 Donggang road, Shijiazhuang, Hebei, China (B.H., Y.W.)
| | - Jun Chen
- Department of Radiology, The Fourth Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China (G.Y., J.C., X.R.).
| | - Xiaocui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical University, No.12 Jiankang road, Shijiazhuang, Hebei, China (G.Y., J.C., X.R.)
| | - Tao Yuan
- Department of Medical imaging, The Second Hospital of Hebei Medical University, No.215 Heping West road, Shijiazhuang, Hebei, China (T.Y., G.Q.)
| | - Guanmin Quan
- Department of Medical imaging, The Second Hospital of Hebei Medical University, No.215 Heping West road, Shijiazhuang, Hebei, China (T.Y., G.Q.)
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Yi X, Wang G, Yang Y, Che Y. Development and Validation of a Diagnostic Model for Enhancing Lesions on Breast MRI: Based on Kaiser Score. Acad Radiol 2024:S1076-6332(24)00677-9. [PMID: 39322535 DOI: 10.1016/j.acra.2024.09.028] [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: 08/14/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024]
Abstract
RATIONALE AND OBJECTIVES This study aims to develop and validate a new diagnostic model based on the Kaiser score for preoperative diagnosis of the malignancy probability of enhancing lesions on breast MRI. MATERIALS AND METHODS This study collected consecutive inpatient data (including imaging data, clinical data, and pathological data) from two different institutions. All patients underwent preoperative breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) examinations and were found to have enhancing lesions. These lesions were confirmed as benign or malignant by surgical resection or biopsy pathology (all carcinomas in situ were confirmed by pathology after surgical resection). Data from one institution were used as the training set(284 cases), and data from the other institution were used as the validation set(107 cases). The Kaiser score was directly incorporated into the diagnostic model as a single predictive variable. Other predictive variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Multivariate logistic regression was employed to integrate the Kaiser score and other selected predictive variables to construct a new diagnostic model, presented in the form of a nomogram. Receiver operating characteristic (ROC) curve, DeLong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were adopted to evaluate and compare the discrimination of the diagnostic model for breast enhancing lesions based on Kaiser score (hereinafter referred to as the "breast lesion diagnostic model") and the Kaiser score alone. Calibration curves were used to assess the calibration of the breast lesion diagnostic model, and decision curve analysis (DCA) was used to evaluate the clinical efficacy of the diagnostic model and the Kaiser score. RESULTS LASSO regression indicated that, besides the indicators already included in the Kaiser score system, "age", "MIP sign", "associated imaging features", and "clinical breast examination (CBE) results" were other valuable diagnostic parameters for breast enhancing lesions. In the training set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.948 and 0.869, respectively, with a statistically significant difference (p < 0.05). In the validation set, the AUCs of the breast lesion diagnostic model and the Kaiser score were 0.956 and 0.879, respectively, with a statistically significant difference (p < 0.05). The DeLong test, NRI, and IDI showed that the breast lesion diagnostic model had a higher discrimination ability for breast enhancing lesions compared to the Kaiser score alone, with statistically significant differences (p < 0.05). The calibration curves indicated good calibration of the breast lesion diagnostic model. DCA demonstrated that the breast lesion diagnostic model had higher clinical application value, with greater net clinical benefit over a wide range of diagnostic thresholds compared to the Kaiser score. CONCLUSION The Kaiser score-based breast lesion diagnostic model, which integrates "age," "MIP sign", "associated imaging features", and "CBE results", can be used for the preoperative diagnosis of the malignancy probability of breast enhancing lesions, and it outperforms the classic Kaiser score in terms of diagnostic performance for such lesions.
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Affiliation(s)
- Xi Yi
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha 410016, China (X.Y., Y.C.).
| | - Guiliang Wang
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha 410016, China (X.Y., Y.C.).
| | - Yu Yang
- Department of Radiology, the First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China (Y.Y.).
| | - Yilei Che
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha 410016, China (X.Y., Y.C.).
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Zhang B, Guo Z, Lei Z, Liang W, Chen X. Kaiser score diagnosis of breast MRI lesions: Factors associated with false-negative and false-positive results. Eur J Radiol 2024; 178:111641. [PMID: 39053308 DOI: 10.1016/j.ejrad.2024.111641] [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: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE We sought factors associated with false-negative and false-positive results in the diagnosis of breast lesions using the Kaiser score (KS) on breast magnetic resonance imaging (MRI). METHODS We retrospectively analyzed 1058 patients with 1058 breast lesions who underwent preoperative breast MRI with successful histopathologic results. Two radiologists assessed each lesion according to KS criteria, and clinicopathologic features and MRI findings were analyzed. Multivariate regression analysis was conducted to identify factors associated with false-negative and false-positive KS results. RESULTS Of the 1058 lesions, 859 were malignant and 199 were benign. Particularly high misdiagnosis rates were observed for intraductal papilloma, inflammatory lesion, and mucinous carcinoma. For breast cancer, KS yielded 821 (95.6 %) true-positive and 38 (4.4 %) false-negative results. Multivariate analysis showed that smaller lesion size (≤1 cm) (OR, 3.698; 95 %CI, 1.430-9.567; p = 0.007), absence of ipsilateral breast hypervascularity (OR, 3.029; 95 %CI, 1.370-6.693; p = 0.006), and presence of hyperintensity on T2WI (OR, 2.405; 95 %CI, 1.121-5.162; p = 0.024) were significantly associated with false-negative breast cancer results. For benign lesions, KS yielded 141 (70.9 %) true-negative and 58 (29.1 %) false-positive results. Multivariate regression analysis revealed that non-mass enhancement lesions (OR, 4.660; 95 %CI, 2.018-10.762; p<0.001), moderate/high background parenchymal enhancement (OR, 2.402; 95 %CI, 1.180-4.892; p = 0.016), and the presence of hyperintensity on T2WI (OR, 2.986; 95 %CI, 1.386-6.433; p = 0.005) were significantly associated with false-positive KS results. CONCLUSION Several clinicopathologic and MRI features influence the accuracy of KS diagnosis. Understanding these factors may facilitate appropriate use of KS and guide alternative diagnostic approaches, ultimately improving diagnostic accuracy in the evaluation of breast lesions.
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Affiliation(s)
- Bing Zhang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Zhuanzhuan Guo
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Zhe Lei
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Wenbin Liang
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China
| | - Xin Chen
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shaanxi, China.
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Coskun Bilge A, Aydin H. Assessment of the contribution of the ADC value to the Kaiser score in the differential diagnosis of breast lesions with non-mass enhancement morphology on MRI. Eur J Radiol 2024; 181:111713. [PMID: 39241300 DOI: 10.1016/j.ejrad.2024.111713] [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: 04/14/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE To investigate the effectiveness of diffusion-weighted imaging (DWI) as a supplementary tool to the Kaiser score (KS) in diagnosing breast cancer in non-mass enhancement (NME) lesions using breast magnetic resonance imaging (MRI). METHODS This single-center, retrospective study analyzed 360 cases with NME on MRI images. Two breast radiologists independently evaluated each lesion using the Kaiser score (KS) and apparent diffusion coefficient (ADC) values, without knowledge of the pathological outcomes. NME lesions with a KS above 4 and an ADC value below 1.3 × 10-3mm2/s were classified as malignant. Inter-rater reliability was determined using Cohen's Kappa (κ) statistics. The diagnostic performance of KS, DWI, and their combination was assessed by calculating sensitivity, specificity, and the area under the curve (AUC), and the results were compared across the benign and malignant groups. RESULTS The diagnostic performance of KS surpassed that of DWI in predicting the malignancy of NMEs (p = 0.003). The sensitivity of KS alone was 93 %; however, when ADC data was incorporated, the sensitivity decreased to 86 %, with no significant difference observed (p = 0.060). The specificity of the combined KS and ADC (94 %) was significantly higher than that of KS alone (89 %) and DWI alone (73 %) (p < 0.001). CONCLUSION Our findings indicated that although the combination of KS and ADC increased specificity and reduced unnecessary biopsies, the resulting decrease in sensitivity was unacceptable. Therefore, KS alone is superior to the KS-ADC combination in detecting malignancy in NME lesions.
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Affiliation(s)
- Almila Coskun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Hale Aydin
- Department of Radiology, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey.
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Zhou J, Liu H, Miao H, Ye S, He Y, Zhao Y, Chen Z, Zhang Y, Liu YL, Pan Z, Su MY, Wang M. Breast lesions on MRI in mass and non-mass enhancement: Kaiser score and modified Kaiser score + for readers of variable experience. Eur Radiol 2024:10.1007/s00330-024-10922-1. [PMID: 38990324 DOI: 10.1007/s00330-024-10922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 03/23/2024] [Accepted: 05/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To compare the diagnostic performance of three readers using BI-RADS and Kaiser score (KS) based on mass and non-mass enhancement (NME) lesions. METHODS A total of 630 lesions, 393 malignant and 237 benign, 458 mass and 172 NME, were analyzed. Three radiologists with 3 years, 6 years, and 13 years of experience made diagnoses. 596 cases had diffusion-weighted imaging, and the apparent diffusion coefficient (ADC) was measured. For lesions with ADC > 1.4 × 10-3 mm2/s, the KS was reduced by 4 as the modified KS +, and the benefit was assessed. RESULTS When using BI-RADS, AUC was 0.878, 0.915, and 0.941 for mass, and 0.771, 0.838, 0.902 for NME for Reader-1, 2, and 3, respectively, better for mass than for NME. The diagnostic accuracy of KS was improved compared to BI-RADS for less experienced readers. For Reader-1, AUC was increased from 0.878 to 0.916 for mass (p = 0.005) and from 0.771 to 0.822 for NME (p = 0.124). Based on the cut-off value of BI-RADS ≥ 4B and KS ≥ 5 as malignant, the sensitivity of KS by Readers-1 and -2 was significantly higher for both Mass and NME. When ADC was considered to change to modified KS +, the AUC and the accuracy for all three readers were improved, showing higher specificity with slightly degraded sensitivity. CONCLUSION The benefit of KS compared to BI-RADS was most noticeable for the less experienced readers in improving sensitivity. Compared to KS, KS + can improve specificity for all three readers. For NME, the KS and KS + criteria need to be further improved. CLINICAL RELEVANCE STATEMENT KS provides an intuitive method for diagnosing lesions on breast MRI. BI-RADS and KS face greater difficulties in evaluating NME compared to mass lesions. Adding ADC to the KS can improve specificity with slightly degraded sensitivity. KEY POINTS KS provides an intuitive method for interpreting breast lesions on MRI, most helpful for novice readers. KS, compared to BI-RADS, improved sensitivity in both mass and NME groups for less experienced readers. NME lesions were considered during the development of the KS flowchart, but may need to be better defined.
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Affiliation(s)
- Jiejie Zhou
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Huiru Liu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Miao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuxin Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun He
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Youfan Zhao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongwei Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Yan-Lin Liu
- Department of Radiological Sciences, University of California, Irvine, CA, US
| | - Zhifang Pan
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, US.
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Meihao Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Pötsch N, Clauser P, Kapetas P, Baykara Ulusan M, Helbich T, Baltzer P. Enhancing the Kaiser score for lesion characterization in unenhanced breast MRI. Eur J Radiol 2024; 176:111520. [PMID: 38820953 DOI: 10.1016/j.ejrad.2024.111520] [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: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To adapt the methodology of the Kaiser score, a clinical decision rule for lesion characterization in breast MRI, for unenhanced protocols. METHOD In this retrospective IRB-approved cross-sectional study, we included 93 consecutive patients who underwent breast MRI between 2021 and 2023 for further work-up of BI-RADS 0, 3-5 in conventional imaging or for staging purposes (BI-RADS 6). All patients underwent biopsy for histologic verification or were followed for a minimum of 12 months. MRI scans were conducted using 1.5 T or 3 T scanners using dedicated breast coils and a protocol in line with international recommendations including DWI and ADC. Lesion characterization relied solely on T2w and DWI/ADC-derived features (such as lesion type, margins, shape, internal signal, surrounding tissue findings, ADC value). Statistical analysis was done using decision tree analysis aiming to distinguish benign (histology/follow-up) from malignant outcomes. RESULTS We analyzed a total of 161 lesions (81 of them non-mass) with a malignancy rate of 40%. Lesion margins (spiculated, irregular, or circumscribed) were identified as the most important criterion within the decision tree, followed by the ADC value as second most important criterion. The resulting score demonstrated a strong diagnostic performance with an AUC of 0.840, providing both rule-in and rule-out criteria. In an independent test set of 65 lesions the diagnostic performance was verified by two readers (AUC 0.77 and 0.87, kappa: 0.62). CONCLUSIONS We developed a clinical decision rule for unenhanced breast MRI including lesion margins and ADC value as the most important criteria, achieving high diagnostic accuracy.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Baykara Ulusan
- Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Org. Abdurrahman Nafiz Gurman Cad, No:1 Fatih, İstanbul, Turkey
| | - T Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Dietzel M, Laun FB, Heiß R, Wenkel E, Bickelhaupt S, Hack C, Uder M, Ohlmeyer S. Initial experience with a next-generation low-field MRI scanner: Potential for breast imaging? Eur J Radiol 2024; 173:111352. [PMID: 38330534 DOI: 10.1016/j.ejrad.2024.111352] [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: 01/27/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Broader clinical adoption of breast magnetic resonance imaging (MRI) faces challenges such as limited availability and high procedural costs. Low-field technology has shown promise in addressing these challenges. We report our initial experience using a next-generation scanner for low-field breast MRI at 0.55T. METHODS This initial cases series was part of an institutional review board-approved prospective study using a 0.55T scanner (MAGNETOM Free.Max, Siemens Healthcare, Erlangen/Germany: height < 2 m, weight < 3.2 tons, no quench pipe) equipped with a seven-channel breast coil (Noras, Höchberg/Germany). A multiparametric breast MRI protocol consisting of dynamic T1-weighted, T2-weighted, and diffusion-weighted sequences was optimized for 0.55T. Two radiologists with 12 and 20 years of experience in breast MRI evaluated the examinations. RESULTS Twelve participants (mean age: 55.3 years, range: 36-78 years) were examined. The image quality was diagnostic in all examinations and not impaired by relevant artifacts. Typical imaging phenotypes were visualized. The scan time for a complete, non-abbreviated breast MRI protocol ranged from 10:30 to 18:40 min. CONCLUSION This initial case series suggests that low-field breast MRI is feasible at diagnostic image quality within an acceptable examination time.
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Affiliation(s)
- Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Frederik B Laun
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Rafael Heiß
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Evelyn Wenkel
- Radiologie München, Burgstrasse 7, 80331 München, Germany.
| | - Sebastian Bickelhaupt
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Carolin Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstraße 21/23, 91054 Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Sabine Ohlmeyer
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
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Pötsch N, Vatteroni G, Clauser P, Rainer E, Kapetas P, Milos R, Helbich TH, Baltzer P. Using the Kaiser Score as a clinical decision rule for breast lesion classification: Does computer-assisted curve type analysis improve diagnosis? Eur J Radiol 2024; 170:111271. [PMID: 38185026 DOI: 10.1016/j.ejrad.2023.111271] [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: 11/15/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE We aimed to investigate the effect of using visual or automatic enhancement curve type assessment on the diagnostic performance of the Kaiser Score (KS), a clinical decision rule for breast MRI. METHOD This IRB-approved retrospective study analyzed consecutive conventional BI-RADS 0, 4 or 5 patients who underwent biopsy after 1.5T breast MRI according to EUSOBI recommendations between 2013 and 2015. The KS includes five criteria (spiculations; signal intensity (SI)-time curve type; margins of the lesion; internal enhancement; and presence of edema) resulting in scores from 1 (=lowest) to 11 (=highest risk of breast cancer). Enhancement curve types (Persistent, Plateau or Wash-out) were assessed by two radiologists independently visually and using a pixel-wise color-coded computed parametric map of curve types. KS diagnostic performance differences between readings were compared by ROC analysis. RESULTS In total 220 lesions (147 benign, 73 malignant) including mass (n = 148) and non-mass lesions (n = 72) were analyzed. KS reading performance in distinguishing benign from malignant lesions did not differ between visual analysis and parametric map (P = 0.119; visual: AUC 0.875, sensitivity 95 %, specificity 63 %; and map: AUC 0.901, sensitivity 97 %, specificity 65 %). Additionally, analyzing mass and non-mass lesions separately, showed no difference between parametric map based and visual curve type-based KS analysis as well (P = 0.130 and P = 0.787). CONCLUSIONS The performance of the Kaiser Score is largely independent of the curve type assessment methodology, confirming its robustness as a clinical decision rule for breast MRI in any type of breast lesion in clinical routine.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - G Vatteroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - E Rainer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - R Milos
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Meng L, Zhao X, Guo J, Lu L, Cheng M, Xing Q, Shang H, Zhang B, Chen Y, Zhang P, Zhang X. Improved Differential Diagnosis Based on BI-RADS Descriptors and Apparent Diffusion Coefficient for Breast Lesions: A Multiparametric MRI Analysis as Compared to Kaiser Score. Acad Radiol 2023; 30 Suppl 2:S93-S103. [PMID: 37236897 DOI: 10.1016/j.acra.2023.03.035] [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: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/28/2023]
Abstract
RATIONALE AND OBJECTIVES To develop the nomogram utilizing the American College of Radiology BI-RADS descriptors, clinical features, and apparent diffusion coefficient (ADC) to differentiate benign from malignant breast lesions. MATERIALS AND METHODS A total of 341 lesions (161 malignant and 180 benign) were included. Clinical data and imaging features were reviewed. Univariable and multivariable logistic regression analyses were performed to determine the independent variables. ADC as a continuous or classified into binary form with a cutoff value of 1.30 × 10-3 mm2/s, incorporated other independent predictors to construct two nomograms, respectively. Receiver operating curve and calibration plot was employed to test the models' discriminative ability. The diagnostic performance between the developed model and the Kaiser score (KS) was also compared. RESULTS In both models, high patient age, the presence of root sign, time-intensity curves (TICs) types (plateau and washout), heterogenous internal enhancement, the presence of peritumoral edema, and ADC were independently associated with malignancy. The AUCs of two multivariable models (AUC, 0.957; 95% CI: 0.929-0.976 and AUC, 0.958; 95% CI: 0.931-0.976) were significantly higher than that of the KS (AUC, 0.919, 95% CI: 0.885-0.946; both P < 0.001). At the same sensitivity of 95.7%, our models showed an increase in specificity by 5.56% (P = 0.076) and 6.11% (P = 0.035), respectively, as compared to the KS. CONCLUSION The models incorporating MRI features (root sign, TIC, margins, internal enhancement, and presence of edema), quantitative ADC value, and patient age showed improved diagnostic performance and might have avoided more unnecessary biopsies in comparison with the KS, although further external validation is required.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.); Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China (L.M., P.Z.).
| | - Xin Zhao
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Jinxia Guo
- General Electric (GE) Healthcare, Beijing, China (J.G.).
| | - Lin Lu
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Meiying Cheng
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Qingna Xing
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Honglei Shang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Bohao Zhang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (B.Z.).
| | - Yan Chen
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
| | - Penghua Zhang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.); Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China (L.M., P.Z.).
| | - Xiaoan Zhang
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (L.M., X.Z., L.L., M.C., Q.X., H.S., Y.C., P.Z., X.Z.).
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Pan J, Huang X, Yang S, Ouyang F, Ouyang L, Wang L, Chen M, Zhou L, Du Y, Chen X, Deng L, Hu Q, Guo B. The added value of apparent diffusion coefficient and microcalcifications to the Kaiser score in the evaluation of BI-RADS 4 lesions. Eur J Radiol 2023; 165:110920. [PMID: 37320881 DOI: 10.1016/j.ejrad.2023.110920] [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: 04/27/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To explore the added value of combining microcalcifications or apparent diffusion coefficient (ADC) with the Kaiser score (KS) for diagnosing BI-RADS 4 lesions. METHODS This retrospective study included 194 consecutive patients with 201 histologically verified BI-RADS 4 lesions. Two radiologists assigned the KS value to each lesion. Adding microcalcifications, ADC, or both these criteria to the KS yielded KS1, KS2, and KS3, respectively. The potential of all four scores to avoid unnecessary biopsies was assessed using the sensitivity and specificity. Diagnostic performance was evaluated by the area under the curve (AUC) and compared between KS and KS1. RESULTS The sensitivity of KS, KS1, KS2, and KS3 ranged from 77.1% to 100.0%.KS1 yielded significantly higher sensitivity than other methods (P < 0.05), except for KS3 (P > 0.05), most of all, when assessing NME lesions. For mass lesions, the sensitivity of these four scores was comparable (p > 0.05). The specificity of KS, KS1, KS2, and KS3 ranged from 56.0% to 69.4%, with no statistically significant differences(P > 0.05), except between KS1 and KS2 (p < 0.05).The AUC of KS1 (0.877) was significantly higher than that of KS (0.837; P = 0.0005), particularly for assessing NME (0.847 vs 0.713; P < 0.0001). CONCLUSION KS can stratify BI-RADS 4 lesions to avoid unnecessary biopsies. Adding microcalcifications, but not adding ADC, as an adjunct to KS improves diagnostic performance, particularly for NME lesions. ADC provides no additional diagnostic benefit to KS. Thus, only combining microcalcifications with KS is most conducive to clinical practice.
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Affiliation(s)
- Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xiyi Huang
- Department of Clinical Laboratory, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Shaomin Yang
- Department of Radiology, Lecong Hospital of Shunde, Foshan, Guangdong, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lizhu Ouyang
- Department of Ultrasound, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Liwen Wang
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Ming Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lanni Zhou
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University(The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
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Kang Y, Li Z, Yang G, Xue J, Zhang L, Rong X. Diagnostic performance of the Kaiser score in the evaluation of breast lesions on contrast-enhanced mammography. Eur J Radiol 2022; 156:110524. [PMID: 36126352 DOI: 10.1016/j.ejrad.2022.110524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate whether the Kaiser score (KS) could improve the diagnostic performance of breast imaging reporting and data system (BI-RADS) in evaluating breast enhancing lesions on contrast-enhanced mammography (CEM). METHODS Three hundred fifty-nine patients with 375 lesions (231 malignant and 144 benign) were included in this retrospective study from April 2019 to December 2021.Two readers with different levels of experience in breast imaging were asked to give a BI-RADS assessment category according to the CEM BI-RADS and final score based on the KS. The diagnostic performance of all lesions, mass and non-mass enhancement (NME) were assessed by receiver operating characteristic (ROC) analysis, and the areas under the ROC curve (AUCs) were measured. The weighted kappa coefficients were calculated to investigate the interreader agreement. RESULTS The AUCs of the KS for all lesions were 0.915 (95 %CI: 0.884-0.947) and 0.876 (95 %CI: 0.838-0.914) for two readers. When mass and NME were evaluated separately, the AUCs of the KS for mass were higher than those for NME (p < 0.001). The AUCs of BI-RADS for all lesion diagnoses ranged between 0.821 (95 %CI: 0.778-0.864) and 0.842(95 %CI: 0.801-0.883) for two readers. The AUCs of the KS were higher than those of BI-RADS (p < 0.001, p = 0.016). There were no significant differences in the sensitivity between the KS (97.4 %) and BI-RADS (99.6 %) for all lesions (p = 0.130). The specificity of the KS was significantly higher than that of BI-RADS (p < 0.001). Compared with BI-RADS, the application of the KS could have potentially obviated 41.7 % to 47.9 % unnecessary biopsies in 144 benign lesions. Interreader agreement between the two readers of the KS was almost perfect (k = 0.883 [95 % CI: 0.842-0.924]). CONCLUSION The use of the KS provided a high diagnostic performance in distinguishing malignant and benign breast lesions on CEM and outperformed BI-RADS. The application of the KS can downgrade up to 47.9% of unnecessary biopsies of benign breast lesions.
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Affiliation(s)
- Yihe Kang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Zhigang Li
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Guang Yang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Jing Xue
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Lingling Zhang
- Department of Pathology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Xiaocui Rong
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
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Pötsch N, Korajac A, Stelzer P, Kapetas P, Milos RI, Dietzel M, Helbich TH, Clauser P, Baltzer PAT. Breast MRI: does a clinical decision algorithm outweigh reader experience? Eur Radiol 2022; 32:6557-6564. [PMID: 35852572 PMCID: PMC9474540 DOI: 10.1007/s00330-022-09015-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/30/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
Objectives Due to its high sensitivity, DCE MRI of the breast (MRIb) is increasingly used for both screening and assessment purposes. The Kaiser score (KS) is a clinical decision algorithm, which formalizes and guides diagnosis in breast MRI and is expected to compensate for lesser reader experience. The aim was to evaluate the diagnostic performance of untrained residents using the KS compared to off-site radiologists experienced in breast imaging using only MR BI-RADS. Methods Three off-site, board-certified radiologists, experienced in breast imaging, interpreted MRIb according to the MR BI-RADS scale. The same studies were read by three residents in radiology without prior training in breast imaging using the KS. All readers were blinded to clinical information. Histology was used as the gold standard. Statistical analysis was conducted by comparing the AUC of the ROC curves. Results A total of 80 women (median age 52 years) with 93 lesions (32 benign, 61 malignant) were included. The individual within-group performance of the three expert readers (AUC 0.723–0.742) as well as the three residents was equal (AUC 0.842–0.928), p > 0.05, respectively. But, the rating of each resident using the KS significantly outperformed the experts’ ratings using the MR BI-RADS scale (p ≤ 0.05). Conclusion The KS helped residents to achieve better results in reaching correct diagnoses than experienced radiologists empirically assigning MR BI-RADS categories in a clinical “problem solving MRI” setting. These results support that reporting breast MRI benefits more from using a diagnostic algorithm rather than expert experience. Key Points • Reporting breast MRI benefits more from using a diagnostic algorithm rather than expert experience in a clinical “problem solving MRI” setting. • The Kaiser score, which provides a clinical decision algorithm for structured reporting, helps residents to reach an expert level in breast MRI reporting and to even outperform experienced radiologists using MR BI-RADS without further formal guidance. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-09015-8.
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Affiliation(s)
- Nina Pötsch
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Aida Korajac
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Philipp Stelzer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Panagiotis Kapetas
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Matthias Dietzel
- Institute of Radiology, Erlangen University Hospital, Maximiliansplatz 2, 91054, Erlangen, Germany
| | - Thomas H Helbich
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Paola Clauser
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Pascal A T Baltzer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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