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Chikarmane SA, Smith S. Background Parenchymal Enhancement: A Comprehensive Update. Radiol Clin North Am 2024; 62:607-617. [PMID: 38777537 DOI: 10.1016/j.rcl.2023.12.013] [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] [Indexed: 05/25/2024]
Abstract
Breast MR imaging is a complementary screening tool for patients at high risk for breast cancer and has been used in the diagnostic setting. Normal enhancement of breast tissue on MR imaging is called breast parenchymal enhancement (BPE), which occurs after administration of an intravenous contrast agent. BPE varies widely due to menopausal status, use of exogenous hormones, and breast cancer treatment. Degree of BPE has also been shown to influence breast cancer risk and may predict treatment outcomes. The authors provide a comprehensive update on BPE with review of the recent literature.
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Affiliation(s)
- Sona A Chikarmane
- Breast Imaging Division, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Sharon Smith
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Sallam H, Lenga L, Solbach C, Becker S, Vogl TJ. Correlation of background parenchymal enhancement on breast MRI with breast cancer. Clin Radiol 2023:S0009-9260(23)00218-0. [PMID: 37330320 DOI: 10.1016/j.crad.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 03/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023]
Abstract
AIM To evaluate the prognostic value of background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) in women referred to radiological department as a high risk for breast cancer. MATERIALS AND METHODS A retrospective, cross-sectional study included 327 consecutive patients (mean age: 60 years, age range: 30-90 years) who underwent breast MRI and tissue biopsy between 2007 and 2016. All MRI images (T1, T2, and subtraction images) were evaluated visually. The relationship of BPE with patient age, fibroglandular tissue (FGT), Breast Imaging Reporting and Data System (BIRADS) categories, presence of breast cancer, and expression of human epidermal growth factor receptor 2 (HER2), progesterone receptor (PR), oestrogen receptor (ER), and Ki67 were analysed. Furthermore, all variables were correlated with pre- and postmenopausal status. RESULTS BPE of bilateral breast showed a weak correlation with FGT (right BPE: r=-0.14, p=0.004; left BPE: r=0.16, p=0.003), a weak negative correlation with patient age (right BPE: r=-0.14, p=0.007; left BPE: r=-0.15, p=0.006), and significant correlation with HER2 (right BPE, p=0.02), left BPE with HER2 was not significant. Among the correlations between BPE and BIRADS, only between right BPE and right BIRADS was significant (p=0.031). No clear evidence of an association between breast MRI BPE and breast cancer in premenopausal and postmenopausal status was observed, and no difference was found between the right and left breasts. CONCLUSIONS The results of the present study showed no significant correlations between BPE and breast cancer. In addition, there was no significant difference between the right and left breast. Hence, BPE of MRI may not be a reliable biomarker of breast cancer development.
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Affiliation(s)
- H Sallam
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - L Lenga
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Solbach
- Department Gynaecology and Obstetrics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - S Becker
- Department Gynaecology and Obstetrics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T J Vogl
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Bauer E, Levy MS, Domachevsky L, Anaby D, Nissan N. Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: A state-of-the-art review. Clin Imaging 2021; 83:41-50. [PMID: 34953310 DOI: 10.1016/j.clinimag.2021.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/20/2022]
Abstract
Within the past decade, background parenchymal enhancement (BPE) and background parenchymal uptake (BPU) have emerged as novel imaging-derived biomarkers in the diagnosis and treatment monitoring of breast cancer. Growing evidence supports the role of breast parenchyma vascularity and metabolic activity as probable risk factors for breast cancer development. Furthermore, in the presence of a newly-diagnosed breast cancer, added clinically-relevant data was surprisingly found in the respective imaging properties of the non-affected contralateral breast. Evaluation of the contralateral BPE and BPU have been found to be especially instrumental in predicting the prognosis of a patient with breast cancer and even anticipating their response to neoadjuvant chemotherapy. Simultaneously, further research has found a link between these two biomarkers, even though they represent different physical properties. The aim of this review is to provide an up to date summary of the current clinical applications of BPE and BPU as breast cancer imaging biomarkers with the hope that it propels their further usage in clinical practice.
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Affiliation(s)
- Ethan Bauer
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Miri Sklair Levy
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Noam Nissan
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
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You C, Xiao Q, Zhu X, Sun Y, Di G, Liu G, Hou Y, Chen C, Wu J, Shao Z, Gu Y, Hu Z. The clinicopathological and MRI features of patients with BRCA1/2 mutations in familial breast cancer. Gland Surg 2021; 10:262-272. [PMID: 33633982 DOI: 10.21037/gs-20-596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background To determine the histopathological and MRI features of BRCA1/2 mutation-associated familial breast cancers compared with those of BRCA1/2 mutation-negative and sporadic breast cancers and to further compare the imaging features of cancers from BRCA1 and BRCA2 mutation carriers according to lesion type on MRI. Methods A retrospective review of medical records was conducted to determine tumour clinicopathologic features and MRI characteristics between June 2011 and July 2017, and 93 lesions with BRCA mutations, 93 lesions without BRCA mutations from familial breast cancers and 93 lesions from sporadic breast cancers were included. Histopathologic data, including immunohistochemistry findings and MRI data according to the BI-RADS lexicon, were reviewed. The association between MRI or histopathologic findings and BRCA mutations was analysed. Results BRCA-positive familial breast cancers had a higher number of IDCs with high nuclear grade and lymph node metastasis (all P<0.05), while the BRCA-negative group had a significantly lower Ki-67 index (P<0.001). BPE on MRI was found to be significantly lower for BRCA mutations of familial breast cancer (P=0.024). BRCA1 carriers tended to exhibit the triple-negative phenotype with a more benign shape and margin (P=0.006 and 0.019), whereas BRCA2 mutations were associated with the luminal phenotype and more malignant features. Conclusions BRCA mutation carriers had a significantly higher number of IDCs with more aggressive cancer, and BRCA-negative cancers had low proliferation levels. Background features on MRI may help to identify BRCA status, while tumour characteristics can differentiate the BRCA1/2 mutation status, consistent with the differences in their clinicopathologic features.
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Affiliation(s)
- Chao You
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qin Xiao
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyi Zhu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiqun Sun
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Genhong Di
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guangyu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yifeng Hou
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Canming Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yajia Gu
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Hu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Sezgın G, Apaydın M, Etıt D, Atahan MK. Tumor size estimation of the breast cancer molecular subtypes using imaging techniques. Med Pharm Rep 2020; 93:253-259. [PMID: 32832890 PMCID: PMC7418834 DOI: 10.15386/mpr-1476] [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] [Received: 09/23/2019] [Revised: 01/01/2020] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aim In medical practice the classification of breast cancer is most commonly based on the molecular subtypes, in order to predict the disease prognosis, avoid over-treatment, and provide individualized cancer management. Tumor size is a major determiner of treatment planning, acting on the decision-making process, whether to perform breast surgery or administer neoadjuvant chemotherapy. Imaging methods play a key role in determining the tumor size in breast cancers at the time of the diagnosis. We aimed to compare the radiologically determined tumor sizes with the corresponding pathologically determined tumor sizes of breast cancer at the time of the diagnosis, in correlation with the molecular subtypes. Methods Ninety-one patients with primary invasive breast cancer were evaluated. The main molecular subtypes were luminal A, luminal B, HER-2 positive, and triple-negative. The Bland-Altman plot was used for presenting the limits of agreement between the radiologically and the pathologically determined tumor sizes by the molecular subtypes. Results A significantly proportional underestimation was found for the luminal A subtype, especially for large tumors. The p-values for the magnetic resonance imaging, mammography, and ultrasonography were 0.020, 0.030, and <0.001, respectively. No statistically significant differences were observed among the radiologic modalities in determining the tumor size in the remaining molecular subtypes (p>0.05). Conclusion The radiologically determined tumor size was significantly smaller than the pathologically determined tumor size in the luminal A subtype of breast cancers when measured with all three imaging modalities. The differences were more prominent with ultrasonography and mammography. The underestimation rate increases as the tumor gets larger.
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Affiliation(s)
- Gulten Sezgın
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Melda Apaydın
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Demet Etıt
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Murat Kemal Atahan
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
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Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon. Ultrasound Q 2020; 36:179-191. [PMID: 32511210 DOI: 10.1097/ruq.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.
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Quantitative background parenchymal enhancement to predict recurrence after neoadjuvant chemotherapy for breast cancer. Sci Rep 2019; 9:19185. [PMID: 31844135 PMCID: PMC6914793 DOI: 10.1038/s41598-019-55820-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/29/2019] [Indexed: 01/02/2023] Open
Abstract
Breast background parenchymal enhancement (BPE) is an increasingly studied MRI parameter that reflects the microvasculature of normal breast tissue, which has been shown to change during neoadjuvant chemotherapy (NAC) for breast cancer. We aimed at evaluating the BPE in patients undergoing NAC and its prognostic value to predict recurrence. MRI BPE was visually and quantitatively evaluated before and after NAC in a retrospective cohort of 102 women with unilateral biopsy-proven invasive breast cancer. Pre-therapeutic BPE was not predictive of pathological response or recurrence. Quantitative post-therapeutic BPE was significantly decreased compared to pre-therapeutic value. Post-therapeutic quantitative BPE significantly predicted recurrence (HR = 6.38 (0.71, 12.06), p < 0.05).
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Thompson CM, Mallawaarachchi I, Dwivedi DK, Ayyappan AP, Shokar NK, Lakshmanaswamy R, Dwivedi AK. The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis. Radiology 2019; 292:552-561. [PMID: 31237494 DOI: 10.1148/radiol.2019182441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundThe higher level of background parenchymal enhancement (BPE) at breast MRI has the potential for early detection and prediction of the risk of breast cancer. However, conflicting findings have been reported about the association between the level of BPE at breast MRI and the presence of breast cancer.PurposeTo evaluate the association between qualitative and quantitative BPE at dynamic contrast material-enhanced MRI and breast cancer among populations with average risk and high risk separately.Materials and MethodsA retrospective meta-analysis of observational studies comparing either qualitative or quantitative assessments of BPE in women with and women without breast cancer was performed for studies published through July 2018. Pooled odds ratios (ORs) or standardized mean differences and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. The heterogeneity across the studies was measured by using the statistic I 2. Sensitivity analyses were conducted to test this association according to different study characteristics. P values less than or equal to 5% were considered to indicate statistically significant results.ResultsEighteen studies comprising 1910 women with breast cancer and 2541 control participants were included in the analysis. Among women with high risk, at least moderate BPE (OR, 1.6; 95% CI: 1.0, 2.6; P = .04) or at least mild BPE (OR, 2.1; 95% CI: 1.5, 3.0; P < .001) was associated with higher odds of breast cancer. Furthermore, women with breast cancer showed a higher average BPE percentage compared with control participants with high risk (standardized mean difference, 0.5; 95% CI: 0.2, 0.9; P = .001). No association was observed between at least mild BPE level (P = .15) or at least moderate BPE level (P = .38) and the presence of breast cancer among the population with average risk.ConclusionA higher level of background parenchymal enhancement measured at breast MRI is associated with the presence of breast cancer in women with high risk, but not in women with average risk.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Mann and Pinker in this issue.
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Affiliation(s)
- Christopher M Thompson
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Indika Mallawaarachchi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Durgesh K Dwivedi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Anoop P Ayyappan
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Navkiran K Shokar
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Rajkumar Lakshmanaswamy
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Alok K Dwivedi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
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