Mammographically detected breast arterial calcifications: indicators for arteriosclerotic diseases?

Assessing breast arterial calcification in mammograms and its implications for atherosclerotic cardiovascular disease risk

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.

Associations of Breast Arterial Calcifications with Cardiovascular Disease

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.

The association between breast arterial calcification and atherosclerotic cardiovascular disease in an Australian population-based breast cancer case-control study

PURPOSE

Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality. Breast arterial calcification (BAC) on mammograms is not associated with breast cancer risk. However, there is increasing evidence supporting its association with cardiovascular disease (CVD). This study examines the association between BAC and ASCVD and their risk factors within an Australian population-based breast cancer study.

MATERIALS AND METHODS

Data from the controls who participated in the breast cancer environment and employment study (BCEES) were linked with the Western Australian Department of Health Hospital Morbidity database and Mortality Registry to obtain ASCVD outcomes and related risk factor data. Mammograms from participants with no prior history of ASCVD were assessed for BAC by a radiologist. Cox proportional hazards regression was used to examine the association between BAC and later occurrence of an ASCVD event. Logistic regression was used to investigate the factors associated with BAC.

RESULTS

A total of 1020 women with a mean age of 60 (sd = 7.0 years) were included and BAC found in 184 (18.0%). Eighty (7.8%) of the 1020 participants developed ASCVD, with an average time to event of 6.2 years (sd = 4.6) from baseline. In univariate analysis, participants with BAC were more likely to have an ASCVD event (HR = 1.96 95% CI 1.29-2.99). However, after adjusting for other risk factors, this association attenuated (HR = 1.37 95% CI 0.88-2.14). Increasing age (OR = 1.15, 95% CI 1.12-1.19) and parity (p_LRT < 0.001) were associated with BAC.

CONCLUSION

BAC is associated with increased ASCVD risk, but this is not independent of cardiovascular risk factors.

Breast Arterial Calcification Rates in a Diverse, Urban Group of Screening Mammography Patients

PURPOSE

Breast arterial calcifications (BAC), detected by digital mammography are a potential marker of coronary artery disease (CAD). Past BAC research has been limited by having primarily racially and ethnically homogeneous samples, samples at higher risk for CAD, and neglecting to explore the influence of women's health factors. The purpose of this study was to evaluate the prevalence of, and factors associated with, BAC in an ethnically and racially diverse group.

METHODS

We conducted a retrospective chart review on 17,237 screening mammography patients. Mammography results and patient responses to a demographic and medical history questionnaire were abstracted. Logistic regression was used.

RESULTS

BAC prevalence was 12.3%. Age was a significant risk factor, with the odds of BAC approximately doubling every decade. Age-adjusted analyses showed: 1) higher BAC prevalence among Hispanic, Black, and Ashkenazi women; 2) lower BAC prevalence among nulliparous and pre-menopausal women, those with dense breasts and breast implants, and those currently using HRT; and 3) no association between BAC prevalence and BMI or age at menarche.

CONCLUSIONS

BAC prevalence differs according to age, ethnicity, race, women's health, and breast-specific factors. Communication of BAC information in clinical settings could potentially prompt women to engage in preventive care.

Breast arterial calcifications as an indicator of atherosclerotic cardiovascular disease: comparative analysis of coronary computed tomography scoring systems and carotid intima-media thickness

BACKGROUND

Breast arterial calcification (BAC) is easily detected and commonly observed on screening mammography. That is more frequent among people with diabetes, and these people are at risk of coronary artery disease. The incidence of BAC increases with advancing age. We aimed to determine whether BAC detected by mammography is associated with the development of coronary atherosclerosis in asymptomatic women. It can help reduce morbidity and mortality secondary to atherosclerotic cardiovascular disease.

METHODS

We included one hundred and eighty women over the age of 40 who underwent mammography screening in this multi-modality study. Mammography evaluated the presence of calcifications, the number of involved arteries, and the distribution. We questioned the patients about cardiovascular risk factors such as hypertension and diabetes. The coronary artery disease severity was assessed according to both Agatston and calcium scores on coronary computed tomography (CT). Besides, the relationship between these scores and correlation with carotid artery intima-media thickness was investigated. We stated mean and standard deviation (SD) for continuous variables and reported frequency distributions and percentages. SPSS software version 25.0 was used to perform the analysis.

RESULTS

Overall, 302 of 3,600 cases were positive for BAC. However, 120 of them could be included in the study by the eligibility criteria of our research. In univariate analysis, age, hyperlipidemia, DM, HT, and smoking history were risk factors that significantly affected BAC development. The impact of age and diabetes were maintained in the logistic regression analysis (P<0.005), while the significant effect of the other variables was vanished (P>0.02). Furthermore, moderate and high BAC scores were correlated with higher coronary atherosclerosis scores.

CONCLUSIONS

BAC may predict an additional risk factor for coronary artery disease, particularly in patients having higher scores. That may be an accurate indicator for subsequent development of coronary arterial calcifications so that it may be possible to reduce morbidity and mortality associated with coronary atherosclerosis.

Reproductive factors and breast arterial calcification: a systematic review and meta-analysis

BACKGROUND

Breast arterial calcification (BAC) is a common incidental finding on screening mammography. Recent evidence suggests that BAC is associated with cardiovascular disease (CVD). We systematically reviewed the associations between BAC and reproductive factors (menopausal status, hormone replacement therapy [HRT] use, oral contraceptive [OC] use and parity).

METHODS

MEDLINE and EMBASE databases, references of relevant papers and Web of Science were searched up to February 2020 for English-language studies that evaluated these associations. Study quality were determined and a random effects model was used to assess these associations.

RESULTS

Nineteen observational studies (n = 47,249; three cohort studies, seven case-control studies, nine cross-sectional studies) were included. BAC was associated with menopause (nine studies; n = 15,870; odds ratio [OR] 2.67; 95% confidence interval [CI] 1.50-4.77) and parity (seven studies; n = 27,728; OR 2.50; 95% CI 1.68-3.71) and inversely with HRT use (10 studies; n = 33,156; OR 0.57; 95% CI 0.40-0.80). No association was found with OC use. Eleven studies were considered good in quality. Marked heterogeneity existed across all analyses.

CONCLUSIONS

BAC is associated with HRT use, menopause and parity. However, careful interpretation is required as marked heterogeneity existed across all analyses. Traditional cardiovascular risk factors may need to be taken into account in future investigations of associations between BAC and reproductive factors.

PROSPERO

CRD42020141644.

Breast Arterial Calcification: A Potential Biomarker for Atherosclerotic Cardiovascular Disease Risk?

PURPOSE OF REVIEW

We aimed to summarize the current evidence regarding the association between breast arterial calcification (BAC) and atherosclerotic cardiovascular disease (ASCVD) in women and discuss the potential role of BAC in the risk stratification and preventive approaches for ASCVD.

RECENT FINDINGS

BAC has emerged as a potential women-specific risk marker for ASCVD. Although BAC presents as a medial calcification of the arteries, notably different from the intimal atherosclerotic process, current evidence supports a correlation between BAC and ASCVD risk factors or subclinical and clinical ASCVD, such as coronary artery disease or stroke. As millions of women undergo mammograms each year, the potential clinical application of BAC in enhanced ASCVD risk estimation, with no additional cost or radiation, has tremendous appeal. Although further research regarding optimal risk assessment and management in women with BAC is required, the presence of BAC should prompt healthy cardiovascular lifestyle modifications.

Is breast arterial calcification associated with coronary artery disease?-A systematic review and meta-analysis

BACKGROUND

There is increasing evidence that breast arterial calcification (BAC), an incidental finding on 3-29% of mammograms, could be used to screen for coronary artery disease (CAD). We conducted a systematic review to assess the associations between BAC and CAD and its risk factors (hypertension, hypercholesterolemia, diabetes mellitus and smoking).

METHODS AND FINDINGS

MEDLINE and EMBASE databases and references of relevant papers were searched up to 18 February 2020 for English language studies that evaluated the associations of BAC and CAD and its risk factors. A single reviewer extracted all data and assessed study quality with verification by another independent reviewer, if required. Across 31 studies (n = 35,583; 3 longitudinal and 28 cross-sectional studies) that examined the association of BAC and CAD, the OR was 2.61 (95% CI 2.12-3.21; I2 = 71%). Sub-analysis of studies that graded BAC severity using the 4- (4 studies) or 12-point scale systems (3 studies) revealed an association with CAD and moderate-severe BAC (OR 4.83 (95%CI 1.50-15.54) and OR 2.95 (95%CI 1.49-5.84), respectively) but not mild BAC (OR 2.04 (95%CI 0.82-5.05) and OR 1.08 (95%CI 0.42-2.75), respectively). BAC was associated with hypertension (42 studies; n = 32,646; OR 1.80; 95% CI 1.47-2.21; I2 = 85%) and diabetes mellitus (51 studies; n = 53,464; OR 2.17; 95% CI 1.82-2.59; I2 = 75%) but not with hypercholesterolemia (OR 1.31; 95%CI 0.97-1.77; I2 = 67%). Smoking was inversely associated with BAC (35 studies; n = 40,002; OR 0.54; 95% CI 0.42-0.70; I2 = 83%). Studies mostly included symptomatic women. Marked heterogeneity existed and publication bias may be present.

CONCLUSIONS

BAC is associated with CAD, diabetes mellitus and hypertension and inversely associated with smoking. Whether BAC could screen for CAD cannot be determined from current published data due to the lack of larger prospective studies. A consensus approach to quantifying BAC may also facilitate further translation into clinical care. PROSPERO: CRD42020141644.

Screening Mammography Findings in Women With Chronic Kidney Disease on a Renal Transplant Waiting List

BACKGROUND

The incidence of breast cancer has been reported to be increased in people with chronic kidney disease (CKD). Thus, breast cancer screening is stated to be mandatory. However, it is as yet unclear what age group or what type of breast structure indicate a need for mammography. This study aimed to evaluate the effects of age and breast parenchymal density on mammography findings. The rate of detection of calcification from mammographies increased in dialysis patients with CKD. The associations of calcifications with comorbid pathologies were also evaluated.

PATIENTS AND METHODS

Patients were divided into the two age groups of 40 to 49.9 years and ≥ 50 years. The patients were asked about smoking habits, hypertension, diabetes mellitus, the pathology that caused CKD, state of hemodialysis, and, if relevant, the type and duration of dialysis.

RESULTS

The mean age of the 55 patients included in this study was 54.8 years, and 78.2% (n = 43) were ≥ 50 years old. The rate of malignancy across the entire group was 3.6%. No association was found between breast arterial calcification and cigarette smoking, hypertension, diabetes mellitus, state of dialysis, duration of dialysis, and breast parenchymal density in any age group.

CONCLUSION

A pretransplantation evaluation of CKD patients may include a breast screening program for patients aged 40 to 49.9 and for the patients aged ≥ 50. Breast parenchymal density was demonstrated to have no effect on the findings, and no association was found between calcifications and comorbid pathologies.

Progression of Medial Arterial Calcification in CKD

Introduction

Medial arterial calcification is common in chronic kidney disease (CKD) and portends poor clinical outcomes, but its progression relative to the severity of CKD and the role of other risk factors is unknown because of the lack of reliable quantification.

Methods

Calcification of breast arteries detected by mammography, which is exclusively medial and correlates with medial calcification in peripheral arteries and with cardiovascular outcomes, was used to measure the progression of medial arterial calcification in women with CKD and end-stage renal disease (ESRD). Measurements showed intra- and interobserver correlations of 0.98, an interstudy variability of 8% to 11%, and a correlation with computed tomographic measurements of 0.92.

Results

Progression of calcification was measured in 60 control subjects (estimated glomerular filtration rate (eGFR) ≥ 90 ml/min per 1.73 m²) and 137 subjects with CKD (eGFR < 90 ml/min per 1.73 m²). Progression in control subjects was linear over time and independent of age. The rate of progression was increased in CKD but only at eGFR < 40 ml/min per 1.73 m² (median, 8.1 vs. 3.9 mm/breast/yr in controls; P = 0.006). Progression accelerated markedly in subjects with ESRD (median, 20 mm/breast/yr; n = 36), but did not differ from controls after kidney transplantation (n = 25). Diabetes significantly augmented progression in subjects with CKD and ESRD but not in controls.

Conclusion

Mammography is a convenient and reliable method to measure the progression of medial arterial calcification. Progression does not increase until advanced stages of CKD, accelerates markedly in ESRD, and returns to control rates after kidney transplantation. Diabetes significantly increases progression in CKD and ESRD.

Can Incidental Vascular Calcifications at Mammography be Used as a Screening Biomarker for Heart and Kidney Disease?

Mammography is a screening test with extensive international application and financial infrastructure promoting accessibility and affordability. Designed specifically to detect microcalcifications, mammography is powered to detect calcifications in vessel walls. Breast arterial calcifications (BAC) are one of the most common incidental findings documented by mammography. This review considers the literature regarding BAC in relation to cardiovascular disease (CVD) and its risk factors. The aim is to assess the possibility of using BAC as an early surrogate imaging biomarker of CVD.

Evaluating the Association between Breast Arterial Calcification and Carotid Plaque Formation

OBJECTIVE

We aimed to evaluate the association between breast arterial calcification (BAC) and carotid plaque formation.

MATERIALS AND METHODS

The study group comprised 47 consecutive BAC (+) women, whereas the control group comprised 33 BAC (-) women (total, 80 women). All mammograms were examined by a specialist without being any apartheid that it was come from central or not. For the exist and density of calcification was used classification method. When we evaluate carotid arterial plaque with Doppler US used scale method. For analyzing categorical variables, we used chi-square test, and for numeric variables, we used independent t-test.

RESULTS

As nearly all BAC+ women had all types of carotid plaques, weighted of them was found that they were fatty plaque type (n=13 %46.4). Only one BAC+ patient was grade 2 and had no carotid plaques (n=1 %3.6). MAK- patients had nearly no plaque types.

CONCLUSION

Breast cancer mammographic evaluation is an already important, cheap, and simple imaging method. In our study, we report a similar cheap, simple method that can be useful for evaluating atherothrombotic atherosclerosis, which is the most important cause of ischemic infarct.

Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events

OBJECTIVE

Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to evaluate and summarize the available evidence on the associations of BAC with cardiovascular risk factors and cardiovascular risk.

METHODS

A systematic literature review and meta-analysis were conducted. Embase and PubMed databases were searched. After critical appraisal, odds ratios were extracted from studies of moderate or good quality that examined risk factors for BAC or associations of BAC with cardiovascular disease. Random effects model meta-analyses were used to calculate pooled odds ratios and 95% confidence intervals (95%CIs).

RESULTS

BAC prevalence is around 12.7% among women in breast cancer screening programs. Increasing age (pooled OR 2.98 [95%CI 2.31-3.85] for every 10 years), diabetes (pooled OR: 1.88 [95%CI 1.36-2.59]) and parity as opposed to nulliparity (pooled OR 3.43 [95%CI 2.23-5.27]) are associated with higher BAC prevalence. Smoking is associated with lower BAC prevalence (pooled OR 0.48 [95%CI 0.39-0.60]). No associations were found with hypertension, obesity or dyslipidemia. Although longitudinal studies (n = 3) were scarce, BAC appear to be associated with an increased risk of cardiovascular disease events (adjusted hazard ratios for coronary heart disease ranging from 1.32 [95%CI 1.08-1.60] to 1.44 [95%CI1.02-2.05]).

CONCLUSION

BAC appear to be associated with an increased risk of cardiovascular disease events, while only being associated with some of the known cardiovascular risk factors, illustrating that medial arterial calcification might contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process.

Mammographically detectable breast arterial calcification and atherosclerosis

Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.

Relationship between breast arterial calcification on mammography with CT Calcium scoring and coronary CT angiography results

Background:

Mammography as a non invasive method has been suggested to be helpful in predicting coronary artery disease. This study aimed to investigate whether presence and severity of breast artery calcification (BAC) on mammograms is associated with computed tomography coronary angiography (CTCA) finding such as coronary artery calcium (CAC) score and the severity of coronary artery stenosis.

Materials and Methods:

This cross-sectional study was performed on 150 women aged >40 years who were referred for CTCA. Women who had undergone screening mammography during the first year after CTCA entered the study. CAC score was determined and the severity of coronary artery stenosis was classified into normal, non-significant stenosis, or significant stenosis. Based on the severity of BAC, patients were also grouped into normal, mild, moderate, or severe groups. Then, the correlation between BAC severity and CAC score was determined. Patients with different BAC severity were also compared regarding the relative frequency of different grades of coronary artery stenosis.

Results:

Mean age of subjects with BAC (n: 35) was significantly higher than patients without BAC (n: 115) (68.03 ± 6.16 versus 54.36 ± 7.63 years, P < 0.0001). Although the relative frequency of different grades of coronary artery stenosis was significantly higher in women with BAC (P < 0.0001), after controlling for age, there was no significant difference between patients with different severity of BAC in the mean of CAC score (P: 0.09). In addition, the correlation between BAC severity and CAC score was not statistically significant (R: 0.09, P: 0.26).

Conclusion:

We concluded that presence and severity of BAC have no significant correlation with CAC score on CTCA.

Relationship between breast arterial calcifications detected on mammography and brachial artery intima-media thickness

PURPOSE

Although breast arterial calcification (BAC) was shown to be related with coronary artery disease (CAD), hypertension (HT), diabetes mellitus (DM) and carotid intima-media thickness (C-IMT), but the association between BAC and brachial intima-media thickness (B-IMT) has not been evaluated yet. Our aim was to investigate whether associations existed between BAC and measure B-IMT and atherosclerosis (AS) by comparing these patients with healthy control subjects.

METHODS

A Total of 75 patients were included in the study. Subjects with or without BAC were assigned into one of two groups and those with a BAC were graded. Main brachial artery IMT was measured.

RESULTS

When the effect of age was partialled out statistically, we found a statistically significant difference in mean B-IMT between BAC (+) (0.54 ± 0.09) and BAC (-) (0.45 ± 0.08) groups (p = 0.001) after the groups were adjusted for age.

CONCLUSIONS

In conclusion, even though the relationship between B-IMT and BAC was significant, like the relationship between C-IMT and BAC, significant age difference between BAC (+) and BAC (-) groups and no significant relationship between BAC and time after menopause, after adjustment for age, suggest a strong association between BAC and age rather than AS. This can be elucidated by pathological correlation studies in larger series of subjects.

The risk for medial arterial calcification in CKD

BACKGROUND AND OBJECTIVES

CKD is a risk factor for medial artery calcification, but the CKD stage at which this risk begins is unknown. Because breast arterial calcification (BAC) is a marker of generalized medial arterial calcification, mammography was used to detect medial arterial calcification in women with different CKD stages.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a retrospective, cross-sectional study of women with and without CKD matched for age and diabetes and identified from mammograms obtained in 2006-2011. BAC was scored as present or absent per visual inspection.

RESULTS

A total of 146 women with stage 3 CKD and 54 with stage 4/5 CKD were identified. An additional 21 patients with ESRD were identified and added to a previous cohort of 71 patients. Mean age was 64 years for CKD 3, 63 for CKD 4, and 59 for ESRD. Half of each group had diabetes. Compared with controls, the odds ratios for BAC were 1.44 in CKD 3 (95% confidence interval [CI], 0.82-2.53), 2.69 in CKD 4 (95% CI, 1.14-6.33), and 7.19 in ESRD (95% CI, 3.77-13.7) and did not differ with diabetic status or race. In a multivariable logistic model, age (P<0.001) and estimated GFR (P=0.005) were independent predictors of BAC. The odds ratio for BAC increased 4% for each milliliter per minute per 1.73 m(2) decrease in estimated GFR. The prevalence of BAC in CKD was increased in each decade of age over 49 years.

CONCLUSIONS

CKD is an independent risk factor for medial arterial calcification.

Risk factors associated with breast arterial calcifications

BACKGROUND

A number of studies have linked the presence of breast arterial calcifications (BACs) with an increased risk of diabetes, hypertension, coronary artery disease (CAD), and cardiovascular mortality. Because there is a well-established screening system for breast cancer, it has been proposed that the presence of BACs can be used as a warning sign indicating an increased risk of metabolic and vascular diseases.

PURPOSE

To determine the relation between BAC and early renal dysfunction.

MATERIAL AND METHODS

A retrospective review of 6118 mammograms identified 701 cases with BACs. Women with BACs were compared to a random selection of 362 women without BACs based on available laboratory data. Univariate analysis was conducted according to age groups.

RESULTS

The prevalence of BACs was 11.5% in our study. Hyperglycemia increased the odds of BACs by 8.1 (95% CI 3.0-22.1, P < 0.001) in the 50-59-year age group. The presence of an elevated blood urea nitrogen (BUN) and serum creatinine increased the odds of BACs by 2.6 (95% CI 1.2-6.0, P = 0.016) and 2.3 (95% CI 1.0-5.2, P = 0.045) in women ≥70 years of age. Hyperlipidemia was not a significant risk factor for BACs in any age group.

CONCLUSION

Our results support the view that the presence of BACs on mammography may be indicative of diabetes in middle-aged women. On the other hand, BACs are not very useful for predicting early renal dysfunction in women <70 years of age.

Mammograms and breast arterial calcifications: looking beyond breast cancer: a preliminary report

BACKGROUND

To find out the prevalence, clinical and biochemical correlates of Breast Artery Calcification (BAC) in the Nigerian women.

FINDINGS

This is a cross sectional study involving 54 consecutive adult female subjects sent to the Radiology Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria for screening and diagnostic mammography. The study was carried out for a period of five months.The prevalence of BAC was 20%. Ageing was found to be related to BAC. Cardiovascular risk factors including diabetes mellitus (DM), hypertension, obesity, alcohol ingestion, use of oral contraceptives and hormone replacement therapy, were not significantly related to the presence of BAC in this study.

CONCLUSION

This study showed that though the presence of BAC in a mammogram is related to age, it may not predict or serve as a significant marker for cardiovascular diseases (CVD) in women in our environment.

Segmentation and quantification of materials with energy discriminating computed tomography: a phantom study

PURPOSE

To experimentally investigate whether a computed tomography (CT) system based on CdZnTe (CZT) detectors in conjunction with a least-squares parameter estimation technique can be used to decompose four different materials.

METHODS

The material decomposition process was divided into a segmentation task and a quantification task. A least-squares minimization algorithm was used to decompose materials with five measurements of the energy dependent linear attenuation coefficients. A small field-of-view energy discriminating CT system was built. The CT system consisted of an x-ray tube, a rotational stage, and an array of CZT detectors. The CZT array was composed of 64 pixels, each of which is 0.8 x 0.8 x 3 mm. Images were acquired at 80 kVp in fluoroscopic mode at 50 ms per frame. The detector resolved the x-ray spectrum into energy bins of 22-32, 33-39, 40-46, 47-56, and 57-80 keV. Four phantoms were constructed from polymethylmethacrylate (PMMA), polyethylene, polyoxymethylene, hydroxyapatite, and iodine. Three phantoms were composed of three materials with embedded hydroxyapatite (50, 150, 250, and 350 mg/ml) and iodine (4, 8, 12, and 16 mg/ml) contrast elements. One phantom was composed of four materials with embedded hydroxyapatite (150 and 350 mg/ml) and iodine (8 and 16 mg/ml). Calibrations consisted of PMMA phantoms with either hydroxyapatite (100, 200, 300, 400, and 500 mg/ml) or iodine (5, 15, 25, 35, and 45 mg/ml) embedded. Filtered backprojection and a ramp filter were used to reconstruct images from each energy bin. Material segmentation and quantification were performed and compared between different phantoms.

RESULTS

All phantoms were decomposed accurately, but some voxels in the base material regions were incorrectly identified. Average quantification errors of hydroxyapatite/iodine were 9.26/7.13%, 7.73/5.58%, and 12.93/8.23% for the three-material PMMA, polyethylene, and polyoxymethylene phantoms, respectively. The average errors for the four-material phantom were 15.62% and 2.76% for hydroxyapatite and iodine, respectively.

CONCLUSIONS

The calibrated least-squares minimization technique of decomposition performed well in breast imaging tasks with an energy resolving detector. This method can provide material basis images containing concentrations of the relevant materials that can potentially be valuable in the diagnostic process.

Least squares parameter estimation methods for material decomposition with energy discriminating detectors

PURPOSE

Energy resolving detectors provide more than one spectral measurement in one image acquisition. The purpose of this study is to investigate, with simulation, the ability to decompose four materials using energy discriminating detectors and least squares minimization techniques.

METHODS

Three least squares parameter estimation decomposition techniques were investigated for four-material breast imaging tasks in the image domain. The first technique treats the voxel as if it consisted of fractions of all the materials. The second method assumes that a voxel primarily contains one material and divides the decomposition process into segmentation and quantification tasks. The third is similar to the second method but a calibration was used. The simulated computed tomography (CT) system consisted of an 80 kVp spectrum and a CdZnTe (CZT) detector that could resolve the x-ray spectrum into five energy bins. A postmortem breast specimen was imaged with flat panel CT to provide a model for the digital phantoms. Hydroxyapatite (HA) (50, 150, 250, 350, 450, and 550 mg/ml) and iodine (4, 12, 20, 28, 36, and 44 mg/ml) contrast elements were embedded into the glandular region of the phantoms. Calibration phantoms consisted of a 30/70 glandular-to-adipose tissue ratio with embedded HA (100, 200, 300, 400, and 500 mg/ml) and iodine (5, 15, 25, 35, and 45 mg/ml). The x-ray transport process was simulated where the Beer-Lambert law, Poisson process, and CZT absorption efficiency were applied. Qualitative and quantitative evaluations of the decomposition techniques were performed and compared. The effect of breast size was also investigated.

RESULTS

The first technique decomposed iodine adequately but failed for other materials. The second method separated the materials but was unable to quantify the materials. With the addition of a calibration, the third technique provided good separation and quantification of hydroxyapatite, iodine, glandular, and adipose tissues. Quantification with this technique was accurate with errors of 9.83% and 6.61% for HA and iodine, respectively. Calibration at one point (one breast size) showed increased errors as the mismatch in breast diameters between calibration and measurement increased. A four-point calibration successfully decomposed breast diameter spanning the entire range from 8 to 20 cm. For a 14 cm breast, errors were reduced from 5.44% to 1.75% and from 6.17% to 3.27% with the multipoint calibration for HA and iodine, respectively.

CONCLUSIONS

The results of the simulation study showed that a CT system based on CZT detectors in conjunction with least squares minimization technique can be used to decompose four materials. The calibrated least squares parameter estimation decomposition technique performed the best, separating and accurately quantifying the concentrations of hydroxyapatite and iodine.

Correlation between breast arterial calcification detected on mammography and cerebral artery disease

PURPOSE

This study was carried out to determine the relationship between breast arterial calcification (BAC) and cerebral artery disease.

MATERIALS AND METHODS

We investigated the relationship between BAC on mammography and cerebral artery-origin T2-hyperintensity on brain MRI and which is associated with an increased risk for stroke. A total of 168 women, ages 40-78 years, who underwent both mammography and brain MRI, were enrolled in this study. BAC was counted as positive if it was found on more than one view a breast. The T2-hyperintensity was systemically defined and graded as follows: punctuate; patchy; and confluent white-matter hyperintensity (WMH); caps; bands; and irregular periventricular hyperintensity (PVH). Patchy and confluent WMH and irregular PVH were considered as positive findings for cerebral artery disease. We also obtained data regarding cardiovascular risk factors that might function as confounding factors. Statistical analysis was performed for association of the BAC and positive MRI findings.

RESULT

The presence of BAC showed a strong correlation with the positive MRI findings (Odds ratios, adjusted with statically significant cardiovascular factors of 6.86 for positive WMH and 9.04 for positive PVH, p < 0.05).

CONCLUSION

The mammographic finding of BAC, which may be a useful marker of women at higher risk for stroke, should receive more of clinicians' attention and its presence should never be omitted from the report.