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Mann RM, Longo V. Contrast-enhanced Mammography versus MR Imaging of the Breast. Radiol Clin North Am 2024; 62:643-659. [PMID: 38777540 DOI: 10.1016/j.rcl.2024.02.003] [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 and contrast-enhanced mammography (CEM) are both techniques that employ intravenously injected contrast agent to assess breast lesions. This approach is associated with a very high sensitivity for malignant lesions that typically exhibit rapid enhancement due to the leakiness of neovasculature. CEM may be readily available at the breast imaging department and can be performed on the spot. Breast MR imaging provides stronger enhancement than the x-ray-based techniques and offers higher sensitivity. From a patient perspective, both modalities have their benefits and downsides; thus, patient preference could also play a role in the selection of the imaging technique.
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Affiliation(s)
- Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Valentina Longo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, Rome 00168, Italy
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2
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Kuhl CK. Abbreviated Breast MRI: State of the Art. Radiology 2024; 310:e221822. [PMID: 38530181 DOI: 10.1148/radiol.221822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Abbreviated MRI is an umbrella term, defined as a focused MRI examination tailored to answer a single specific clinical question. For abbreviated breast MRI, this question is: "Is there evidence of breast cancer?" Abbreviated MRI of the breast makes maximum use of the fact that the kinetics of breast cancers and of benign tissue differ most in the very early postcontrast phase; therefore, abbreviated breast MRI focuses on this period. The different published approaches to abbreviated MRI include the following three subtypes: (a) short protocols, consisting of a precontrast and either a single postcontrast acquisition (first postcontrast subtracted [FAST]) or a time-resolved series of postcontrast acquisitions with lower spatial resolution (ultrafast [UF]), obtained during the early postcontrast phase immediately after contrast agent injection; (b) abridged protocols, consisting of FAST or UF acquisitions plus selected additional pulse sequences; and (c) noncontrast protocols, where diffusion-weighted imaging replaces the contrast information. Abbreviated MRI was proposed to increase tolerability of and access to breast MRI as a screening tool. But its widening application now includes follow-up after breast cancer and even diagnostic assessment. This review defines the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility.
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Affiliation(s)
- Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH Pauwelsstr 30, 52074 Aachen, Germany
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Tollens F, Baltzer PA, Froelich MF, Kaiser CG. Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses. Front Oncol 2023; 13:1292268. [PMID: 38130995 PMCID: PMC10733447 DOI: 10.3389/fonc.2023.1292268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Economic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening. Purpose To introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening. Materials and methods The various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed. Results Despite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes. Conclusion Economic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.
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Affiliation(s)
- Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal A.T. Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Clemens G. Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Mann RM. Breast screening: "If you really want to see it, you just make an MRI". Eur Radiol 2023; 33:8410-8412. [PMID: 38041388 DOI: 10.1007/s00330-023-09890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Tsui B, Calabrese E, Zaharchuk G, Rauschecker AM. Reducing Gadolinium Contrast With Artificial Intelligence. J Magn Reson Imaging 2023. [PMID: 37905681 DOI: 10.1002/jmri.29095] [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: 08/03/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Gadolinium contrast is an important agent in magnetic resonance imaging (MRI), particularly in neuroimaging where it can help identify blood-brain barrier breakdown from an inflammatory, infectious, or neoplastic process. However, gadolinium contrast has several drawbacks, including nephrogenic systemic fibrosis, gadolinium deposition in the brain and bones, and allergic-like reactions. As computer hardware and technology continues to evolve, machine learning has become a possible solution for eliminating or reducing the dose of gadolinium contrast. This review summarizes the clinical uses of gadolinium contrast, the risks of gadolinium contrast, and state-of-the-art machine learning methods that have been applied to reduce or eliminate gadolinium contrast administration, as well as their current limitations, with a focus on neuroimaging applications. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Brian Tsui
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Evan Calabrese
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Andreas M Rauschecker
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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Bahl M. The Quest to Reduce the Use of Gadolinium-based Contrast Agents: AI May Provide a Solution. Radiology 2023; 307:e230325. [PMID: 36943082 PMCID: PMC10140636 DOI: 10.1148/radiol.230325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Manisha Bahl
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114
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Müller-Franzes G, Huck L, Tayebi Arasteh S, Khader F, Han T, Schulz V, Dethlefsen E, Kather JN, Nebelung S, Nolte T, Kuhl C, Truhn D. Using Machine Learning to Reduce the Need for Contrast Agents in Breast MRI through Synthetic Images. Radiology 2023; 307:e222211. [PMID: 36943080 DOI: 10.1148/radiol.222211] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Reducing the amount of contrast agent needed for contrast-enhanced breast MRI is desirable. Purpose To investigate if generative adversarial networks (GANs) can recover contrast-enhanced breast MRI scans from unenhanced images and virtual low-contrast-enhanced images. Materials and Methods In this retrospective study of breast MRI performed from January 2010 to December 2019, simulated low-contrast images were produced by adding virtual noise to the existing contrast-enhanced images. GANs were then trained to recover the contrast-enhanced images from the simulated low-contrast images (approach A) or from the unenhanced T1- and T2-weighted images (approach B). Two experienced radiologists were tasked with distinguishing between real and synthesized contrast-enhanced images using both approaches. Image appearance and conspicuity of enhancing lesions on the real versus synthesized contrast-enhanced images were independently compared and rated on a five-point Likert scale. P values were calculated by using bootstrapping. Results A total of 9751 breast MRI examinations from 5086 patients (mean age, 56 years ± 10 [SD]) were included. Readers who were blinded to the nature of the images could not distinguish real from synthetic contrast-enhanced images (average accuracy of differentiation: approach A, 52 of 100; approach B, 61 of 100). The test set included images with and without enhancing lesions (29 enhancing masses and 21 nonmass enhancement; 50 total). When readers who were not blinded compared the appearance of the real versus synthetic contrast-enhanced images side by side, approach A image ratings were significantly higher than those of approach B (mean rating, 4.6 ± 0.1 vs 3.0 ± 0.2; P < .001), with the noninferiority margin met by synthetic images from approach A (P < .001) but not B (P > .99). Conclusion Generative adversarial networks may be useful to enable breast MRI with reduced contrast agent dose. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Gustav Müller-Franzes
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Luisa Huck
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Soroosh Tayebi Arasteh
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Firas Khader
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Tianyu Han
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Volkmar Schulz
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Ebba Dethlefsen
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Jakob Nikolas Kather
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Sven Nebelung
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Teresa Nolte
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Christiane Kuhl
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
| | - Daniel Truhn
- From the Department of Diagnostic and Interventional Radiology (G.M.F., L.H., S.T.A., F.K., E.D., S.N., T.N., C.K., D.T.) and Department of Medicine III (J.N.K.), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany; and Department of Physics of Molecular Imaging Systems, Division of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany (T.H., V.S.)
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Ramalho J, Semelka R, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: An observational study. RADIOLOGIA 2022; 64:397-406. [DOI: 10.1016/j.rxeng.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/13/2020] [Indexed: 10/18/2022]
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Abstract
Purpose To evaluate the clinical feasibility of high-resolution dedicated breast positron emission tomography (dbPET) with real low-dose 18F-2-fluorodeoxy-d-glucose (18F-FDG) by comparing images acquired with full-dose FDG. Materials and methods Nine women with no history of breast cancer and previously scanned by dbPET injected with a clinical 18F-FDG dose (3 MBq/kg) were enrolled. They were injected with 50% of the clinical 18F-FDG dose and scanned with dbPET for 10 min for each breast 60 and 90 min after injection. To investigate the effect of the scan start time and acquisition time on image quality, list-mode data were divided into 1, 3, 5, and 7 min (and 10 min with 50% FDG injected) from the start of acquisition and reconstructed. The reconstructed images were visually and quantitatively compared for contrast between mammary gland and fat (contrast) and for coefficient of variation (CV) in the mammary gland. Results In visual evaluation, the contrast between the mammary gland and fat acquired at a 50% dose for 7 min was comparable and even better in smoothness than that in the images acquired at a 100% dose. No visual difference between the images with a 50% dose was found with scan start times 60 and 90 min after injection. Quantitative evaluation showed a slightly lower contrast in the image at 60 min after 50% dosing, with no difference between acquisition times. There was no difference in CV between conditions; however, smoothness decreased with shorter acquisition time in all conditions. Conclusions The quality of dbPET images with a 50% FDG dose was high enough for clinical application. Although the optimal scan start time for improved lesion-to-background mammary gland contrast remained unknown in this study, it will be clarified in future studies of breast cancer patients.
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Neal CH. Screening Breast MRI and Gadolinium Deposition: Cause for Concern? JOURNAL OF BREAST IMAGING 2022; 4:10-18. [PMID: 38422412 DOI: 10.1093/jbi/wbab074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 03/02/2024]
Abstract
Gadolinium-based contrast agents (GBCAs) have been used worldwide for over 30 years and have enabled lifesaving diagnoses. Contrast-enhanced breast MRI is frequently used as supplemental screening for women with an elevated lifetime risk of breast cancer. Data have emerged that indicate a fractional amount of administered gadolinium is retained in the bone, skin, solid organs, and brain tissues of patients with normal renal function, although there are currently no reliable data regarding the clinical or biological significance of this retention. Linear GBCAs are associated with a higher risk of gadolinium retention than macrocyclic agents. Over the course of their lives, screened women may receive high cumulative doses of GBCA. Therefore, as breast MRI screening utilization increases, thoughtful use of GBCA is indicated in this patient population.
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Affiliation(s)
- Colleen H Neal
- ProMedica Toledo Hospital, ProMedica Breast Care, Toledo, OH, USA
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Lee SC, Hovanessian-Larsen L, Stahl D, Cen S, Lei X, Desai B, Yamashita M. Accuracy of contrast-enhanced spectral mammography compared with MRI for invasive breast cancers: Prospective study in population of predominantly underrepresented minorities. Clin Imaging 2021; 80:364-370. [PMID: 34509973 DOI: 10.1016/j.clinimag.2021.08.015] [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: 04/07/2021] [Revised: 07/01/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This prospective study compares contrast-enhanced spectral mammography (CESM) with contrast-enhanced breast MRI in assessing the extent of newly diagnosed breast cancer in a multiethnic cohort. METHODS This study includes 41 patients with invasive breast cancer detected by mammography or conventional ultrasound imaging from May 2017 to March 2020. CESM and MRI scans were performed prior to any treatment. Results are compared with each other and to histopathology. Detection of the malignant lesion was assessed by sensitivity, specificity, PPV, NPV. Consistency of malignant tumor size measurement was compared between modalities using Intraclass Correlation Coefficient (ICC). RESULTS In a multiethnic cohort with over 65% Hispanic and African-American women, the sensitivity of detecting malignant lesions for CESM is 93.1% (77.23%, 99.15%) and MRI is 96.55% (82.24%, 99.91%). The PPV for CESM 96.43% (81.65%, 99.91%) is better compared to MRI 82.35% (65.47%, 93.24%). CESM is as effective as MRI in evaluating index cancers and multifocal/multicentric/contralateral disease. CESM has greater specificity and PPV since MRI tends to overcall benign lesions. There is a good agreement of tumor size between CESM to surgery and MRI to surgery with ICC of 0.85 (95% CI 0.69, 0.93) and 0.87 (95% CI 0.74, 0.94), respectively. There is good agreement of malignancy detection between CESM and MRI with Kappa of 0.74 (95% CI 0.52, 0.95). CONCLUSIONS CESM is an effective imaging modality for evaluating the extent of disease in newly diagnosed invasive breast cancers and a good alternative to MRI in a multiethnic population.
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Affiliation(s)
- Sandy C Lee
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Linda Hovanessian-Larsen
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Daniel Stahl
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Steven Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Xiaomeng Lei
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Bhushan Desai
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
| | - Mary Yamashita
- Department of Radiology, Keck School of Medicine, University of Southern California, 1200 North State Street, 3rd Floor Room 3750A, Los Angeles, CA 90033, United States of America.
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Influence of aging and gadolinium exposure on T1, T2, and T2*-relaxation in healthy women with an increased risk of breast cancer with and without prior exposure to gadoterate meglumine at 3.0-T brain MR imaging. Eur Radiol 2021; 32:331-345. [PMID: 34218287 PMCID: PMC8660719 DOI: 10.1007/s00330-021-08069-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
Objectives We examined the effects of aging and of gadolinium-based contrast agent (GBCA) exposure on MRI measurements in brain nuclei of healthy women. Methods This prospective, IRB-approved single-center case-control study enrolled 100 healthy participants of our high-risk screening center for hereditary breast cancer, who had received at least six doses of macrocyclic GBCA (exposed group) or were newly entering the program (GBCA-naïve group). The cutoff “at least six doses” was chosen to be able to include a sufficient number of highly exposed participants. All participants underwent unenhanced 3.0-T brain MRI including quantitative T1, T2, and R2* mapping and T1- and T2-weighted imaging. The relaxation times/signal intensities were derived from region of interest measurements in the brain nuclei performed by a radiologist and a neuroradiologist, both board certified. Statistical analysis was based on descriptive evaluations and uni-/multivariable analyses. Results The participants (exposed group: 49, control group: 51) were aged 42 ± 9 years. In a multivariable model, age had a clear impact on R2* (p < 0.001–0.012), T2 (p = 0.003–0.048), and T1 relaxation times/signal intensities (p < 0.004–0.046) for the majority of deep brain nuclei, mostly affecting the substantia nigra, globus pallidus (GP), nucleus ruber, thalamus, and dentate nucleus (DN). The effect of prior GBCA administration on T1 relaxation times was statistically significant for the DN, GP, and pons (p = 0.019–0.037). Conclusions In a homogeneous group of young to middle-aged healthy females aging had an effect on T2 and R2* relaxation times and former GBCA applications influenced the measured T1 relaxation times. Key Points The quantitative T1, T2, and R2* relaxation times measured in women at high risk of developing breast cancer showed characteristic bandwidth for all brain nuclei examined at 3.0-T MRI. The effect of participant age had a comparatively strong impact on R2*, T2, and T1 relaxation times for the majority of brain nuclei examined. The effect of prior GBCA administrations on T1 relaxation times rates was comparatively less pronounced, yielding statistically significant results for the dentate nucleus, globus pallidus, and pons.
Summary statement Healthy women with and without previous GBCA-enhanced breast MRI exhibited age-related T2* and T2 relaxation alterations at 3.0 T-brain MRI. T1 relaxation alterations due to prior GBCA administration were comparatively less pronounced. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08069-4.
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Suh J, Kim JH, Kim SY, Cho N, Kim DH, Kim R, Kim ES, Jang MJ, Ha SM, Lee SH, Chang JM, Moon WK. Noncontrast-Enhanced MR-Based Conductivity Imaging for Breast Cancer Detection and Lesion Differentiation. J Magn Reson Imaging 2021; 54:631-645. [PMID: 33894088 DOI: 10.1002/jmri.27655] [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] [Received: 01/13/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is increasing interest in noncontrast-enhanced MRI due to safety concerns for gadolinium contrast agents. PURPOSE To investigate the clinical feasibility of MR-based conductivity imaging for breast cancer detection and lesion differentiation. STUDY TYPE Prospective. SUBJECTS One hundred and ten women, with 112 known cancers and 17 benign lesions (biopsy-proven), scheduled for preoperative MRI. FIELD STRENGTH/SEQUENCE Non-fat-suppressed T2-weighted turbo spin-echo sequence (T2WI), dynamic contrast-enhanced MRI and diffusion-weighted imaging (DWI) at 3T. ASSESSMENT Cancer detectability on each imaging modality was qualitatively evaluated on a per-breast basis: the conductivity maps derived from T2WI were independently reviewed by three radiologists (R1-R3). T2WI, DWI, and pre-operative digital mammography were independently reviewed by three other radiologists (R4-R6). Conductivity and apparent diffusion coefficient (ADC) measurements (mean, minimum, and maximum) were performed for 112 cancers and 17 benign lesions independently by two radiologists (R1 and R2). Tumor size was measured from surgical specimens. STATISTICAL TESTS Cancer detection rates were compared using generalized estimating equations. Multivariable logistic regression analysis was performed to identify factors associated with cancer detectability. Discriminating ability of conductivity and ADC was evaluated by using the areas under the receiver operating characteristic curve (AUC). RESULTS Conductivity imaging showed lower cancer detection rates (20%-32%) compared to T2WI (62%-71%), DWI (85%-90%), and mammography (79%-88%) (all P < 0.05). Fatty breast on MRI (odds ratio = 11.8, P < 0.05) and invasive tumor size (odds ratio = 1.7, P < 0.05) were associated with cancer detectability of conductivity imaging. The maximum conductivity showed comparable ability to the mean ADC in discriminating between cancers and benign lesions (AUC = 0.67 [95% CI: 0.59, 0.75] vs. 0.84 [0.76, 0.90], P = 0.06 (R1); 0.65 [0.56, 0.73] vs. 0.82 [0.74, 0.88], P = 0.07 (R2)). DATA CONCLUSION Although conductivity imaging showed suboptimal performance in breast cancer detection, the quantitative measurement of conductivity showed the potential for lesion differentiation. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- June Suh
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun-Hyeong Kim
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Hyun Kim
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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Yang ZL, Hu YQ, Huang J, Zhan CA, Zhou MX, Zhang XY, Zhang HT, Xia LM, Ai T. Detection and Classification of Breast Lesions With Readout-Segmented Diffusion-Weighted Imaging in a Large Chinese Cohort. Front Oncol 2021; 11:636471. [PMID: 33828984 PMCID: PMC8020903 DOI: 10.3389/fonc.2021.636471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives: To evaluate the performance of readout-segmented echo-planar imaging DWI (rs-EPI DWI) in detecting and characterizing breast cancers in a large Chinese cohort with comparison to dynamic contrast-enhanced MRI (DCE-MRI). Methods: The institutional review board approved this retrospective study with waived written informed consent. A total of 520 women (mean age, 43.1- ± 10.5-years) were included from July 2013 to October 2019. First, the ability of rs-EPI DWI in detecting breast lesions identified by DCE-MRI was evaluated. The lesion conspicuity of rs-EPI-DWI and DCE-MRI was compared using the Wilcoxon signed rank test. With pathology as a reference, the performance of rs-EPI DWI and DCE-MRI in distinguishing breast cancers was evaluated and compared using the Chi-square test. Results: Of 520 women, 327/520 (62.9%) patients had 423 lesions confirmed by pathology with 203 benign and 220 malignant lesions. The rs-EPI DWI can detect 90.8% (659/726) (reader 1) and 90.6% (663/732) (reader 2) of lesions identified by DCE-MRI. The lesion visibility was superior for DCE-MRI than rs-EPI-DWI (all p < 0.05). With pathology as a reference, the sensitivities and specificities of rs-EPI DWI in diagnosing breast cancers were 95.9% (211/220) and 85.7% (174/203) for reader 1 and 97.7% (215/220) and 86.2% (175/203) for reader 2. No significant differences were found for the performance of DCE-MRI and rs-EPI DWI in discriminating breast cancers (all p > 0.05). Conclusions: Although with an inferior lesion visibility, rs-EPI DWI can detect about 90% of breast lesions identified by DCE-MRI and has comparable diagnostic capacity to that of DCE-MRI in identifying breast cancer.
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Affiliation(s)
- Zhen Lu Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Qi Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Ao Zhan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Xiong Zhou
- College of Medical Imaging, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | | | | | - Li Ming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Can supplementary contrast-enhanced MRI of the breast avoid needle biopsies in suspicious microcalcifications seen on mammography? A systematic review and meta-analysis. Breast 2021; 56:53-60. [PMID: 33618160 PMCID: PMC7907894 DOI: 10.1016/j.breast.2021.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the rate of potentially avoidable needle biopsies in mammographically suspicious calcifications if supplementary Contrast-Enhanced MRI (CE-MRI) is negative. Methods Using predefined criteria, a systematic review was performed. Studies investigating the use of supplemental CE-MRI in the setting of mammographically suspicious calcifications undergoing stereotactic biopsy and published between 2000 and 2020 were eligible. Two reviewers extracted study characteristics and true positives (TP), false positives, true negatives and false negatives (FN). Specificity, in this setting equaling the number of avoidable biopsies and FN rates were calculated. The maximum pre-test probability at which post-test probabilities of a negative CE-MRI met with BI-RADS benchmarks was determined by a Fagan nomogram. Random-effects models, I2-statistics, Deek’s funnel plot testing and meta-regression were employed. P-values <0.05 were considered significant. Results Thirteen studies investigating 1414 lesions with a cancer prevalence of 43.6% (range: 22.7–66.9%) were included. No publication bias was found (P = 0.91). CE-MRI performed better in pure microcalcification studies compared to those also including associate findings (P < 0.001). In the first group, the pooled rate of avoidable biopsies was 80.6% (95%-CI: 64.6–90.5%) while the overall and invasive cancer FN rates were 3.7% (95%-CI: 1.2–6.2%) and 1.6% (95%-CI 0–3.6%), respectively. Up to a pre-test probability of 22%, the post-test probability did not exceed 2%. Conclusion A negative supplementary CE-MRI could potentially avoid 80.6% of unnecessary stereotactic biopsies in BI-RADS 4 microcalcifications at a cost of 3.7% missed breast cancers, 1.6% invasive. BI-RADS benchmarks for downgrading mammographic calcifications would be met up to a pretest probability of 22%. A negative breast MRI can downgrade up to 80.6% of suspicious microcalcifications, potentially avoiding vacuum-assisted breast biopsies. Up to a pretest probability of 22% , a negative breast MRI result would not exceed the 2% cancer rate required for a BI-RADS 3 category assignment.
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Baltzer PAT. Supplemental screening using breast MRI in women with mammographically dense breasts. Eur J Radiol 2020; 136:109513. [PMID: 33422397 DOI: 10.1016/j.ejrad.2020.109513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Kaiser CG, Dietzel M, Vag T, Froelich MF. Cost-effectiveness of MR-mammography vs. conventional mammography in screening patients at intermediate risk of breast cancer - A model-based economic evaluation. Eur J Radiol 2020; 136:109355. [PMID: 33214003 DOI: 10.1016/j.ejrad.2020.109355] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this study was to analyze the cost-effectiveness of screening patients of intermediate risk of breast cancer with MR-Mammography (MRM) versus conventional mammography (XM). METHOD A decision model for both diagnostic modalities and a subsequent markov model for the simulation of follow-up costs and outcomes was developed. Input parameters were acquired from published literature for this markov modelling study. The expected cumulative costs and outcomes were calculated for both modalities in a 30-year timeframe in US-dollar ($) and quality-adjusted life years (QALYs). A deterministic sensitivity analysis and a probabilistic sensitivity analysis incorporating 30,000 Monte Carlo iterations were performed to investigate the model stability. RESULTS In total, XM with its consecutive treatments resulted in total costs of $ 5,492.68 and an average cumulative quality of life of 18.87 QALYs, compared to MRM with costs of $ 5,878.66 and 18.92 QALYs. The corresponding incremental cost-effectiveness ratio (ICER) for MRM was $ 8,797.60 per QALY - distinctly below international willingness-to-pay thresholds for cost-effectiveness. The results were confirmed within the limits of the sensitivity analyses. CONCLUSIONS In patients with intermediate risk for breast cancer due to their dense breast tissue, two-yearly screening with MRM may be considered as cost-effective.
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Affiliation(s)
- Clemens G Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany.
| | - Matthias Dietzel
- Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, Germany
| | - Tibor Vag
- Conradia Radiology & Medical Prevention Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany
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Ramalho J, Semelka RC, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: an observational study. RADIOLOGIA 2020; 64:S0033-8338(20)30112-0. [PMID: 33032813 DOI: 10.1016/j.rx.2020.07.003] [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: 05/07/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND AIMS Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. MATERIALS AND METHODS We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered<15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered. RESULTS The 54 patients (26 men) had received a mean of 13.8±3.47 doses (range, 10-23 doses). The difference in the dentate nucleus-pons signal intensity ratio between the first and last MR study was -0.0275±0.1917 (not significantly different from 0; p=0.2968) in the entire group, -0.0357±0.2204 (not significantly different from 0; p=0.351 in the patients who had received <15 doses (n=34), and -0.0135±0.1332 (not significantly different from 0; p=0.655) in those who had received ≥15 doses (n=20). Differences in signal intensity ratios did not correlate significantly with the accumulated dose of gadoterate meglumine (P=0.9064; ρ=-0.0164 [95%]). CONCLUSIONS Receiving more than 10 doses of gadoterate meglumine was not associated with increased signal intensity in the dentate nucleus.
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Affiliation(s)
- J Ramalho
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - R C Semelka
- Dr. Richard Semelka. Empresa privada de consultoría
| | - J Cruz
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal
| | - T Morais
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - M Ramalho
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal.
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