1
|
Kuemmel S, Heil J, Bruzas S, Breit E, Schindowski D, Harrach H, Chiari O, Hellerhoff K, Bensmann E, Hanf V, Graßhoff ST, Deuschle P, Belke K, Polata S, Paepke S, Warm M, Meiler J, Schindlbeck C, Ruhwedel W, Beckmann U, Groh U, Dall P, Blohmer JU, Traut A, Reinisch M. Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer. JAMA Surg 2023; 158:807-815. [PMID: 37285140 PMCID: PMC10248815 DOI: 10.1001/jamasurg.2023.1772] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/19/2023] [Indexed: 06/08/2023]
Abstract
IMPORTANCE The increasing use of neoadjuvant systemic therapy (NST) has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce. OBJECTIVE To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND. DESIGN, SETTING, AND PARTICIPANTS The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up. EXPOSURE TAD alone vs TAD with ALND. MAIN OUTCOMES AND MEASURES Three-year clinical outcomes were evaluated. RESULTS Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD alone was not associated with an increased risk of recurrence (hazard ratio [HR], 0.83; 95% CI, 0.34-2.05; P = .69) or death (HR, 1.07; 95% CI, 0.31-3.70; P = .91). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74). CONCLUSIONS AND RELEVANCE These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.
Collapse
Affiliation(s)
- Sherko Kuemmel
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Simona Bruzas
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Elisabeth Breit
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | - Hakima Harrach
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Ouafaa Chiari
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Volker Hanf
- Breast Unit Klinikum Fürth, Frauenklinik Nathanstift, Fürth, Germany
| | | | - Petra Deuschle
- Breast Unit, Marienhaus Klinikum Hetzelstift Neustadt/Weinstraße, Neustadt, Germany
| | - Kerstin Belke
- Klinik für Gynäkologie und Geburtshilfe, Robert-Koch-Krankenhaus Apolda, Apolda, Germany
| | - Silke Polata
- Klinik für Innere Medizin/Onkologisches Zentrum, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - Stefan Paepke
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Mathias Warm
- Brustzentrum Holweide, Kliniken der Stadt Köln, Cologne, Germany
| | | | | | - Wencke Ruhwedel
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Gütersloh, Gütersloh, Germany
| | - Ulrike Beckmann
- Brustzentrum der Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Ulrich Groh
- Klinik für Gynäkologie, Geburtshilfe und Senologie, Hochwaldkrankenhaus Bad Nauheim, Bad Nauheim, Germany
| | - Peter Dall
- Brustzentrum und Gynäkologisches Krebszentrum, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
2
|
Hellerhoff K, Dietrich H, Schinner R, Rjosk-Dendorfer D, Sztrókay-Gaul A, Reiser M, Grandl S. Assessment of MRI-Detected Breast Lesions: A Benign Correlate on Second-Look Ultrasound Can Safely Exclude Malignancy. Breast Care (Basel) 2021; 16:435-443. [PMID: 34720802 DOI: 10.1159/000513443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Due to the increasing use of dynamic breast MRI and the limited availability of MR-guided interventions, MRI-detected lesions usually undergo a second-look ultrasound (SLUS). We investigated the safety of a negative SLUS and a benign SLUS correlate in excluding malignant and high-risk lesions (B3) and evaluated criteria for the rate of detection on SLUS. Methods In the retrospective analysis, all breast MRIs performed between 2011 and 2013 were screened for newly detected lesions. We analyzed the SLUS detection rate dependent on breast density, mass character, lesion size, and histology. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a negative and benign SLUS for malignant lesions (B5) and lesions requiring surgical excision (including high-risk and B5 lesions). Results We successfully correlated 110 of 397 lesions. The detection rate was significantly higher for mass than for non-mass lesions and correlated with lesion size for mass lesions only. Lesions without/with a benign SLUS correlate were more frequently benign (including B3) or required no further procedure (B2). The sensitivity of SLUS in the detection of B3 and B5 lesions was 58%, and 73% in the detection of B5 lesions. The NPV of a negative or benign SLUS for B3 and B5 lesions was 89%, and 96% for B5 lesions. Discussion SLUS is a safe diagnostic tool for the management of MRI-detected lesions and can spare patients from undergoing invasive procedures.
Collapse
Affiliation(s)
- Karin Hellerhoff
- Department of Breast Imaging, Red Cross Hospital, Munich, Germany
| | - Hanna Dietrich
- Department of Radiology, University Hospital, LMU, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU, Munich, Germany
| | | | | | | | - Susanne Grandl
- Department of Breast Imaging, Red Cross Hospital, Munich, Germany
| |
Collapse
|
3
|
Heck L, Eggl E, Grandl S, Dierolf M, Jud C, Günther B, Achterhold K, Mayr D, Gleich B, Hellerhoff K, Pfeiffer F, Herzen J. Dose and spatial resolution analysis of grating-based phase-contrast mammography using an inverse Compton x-ray source. J Med Imaging (Bellingham) 2020; 7:023505. [PMID: 32341937 PMCID: PMC7175026 DOI: 10.1117/1.jmi.7.2.023505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Although the mortality rate of breast cancer was reduced with the introduction of screening mammography, many women undergo unnecessary subsequent examinations due to inconclusive diagnoses. Superposition of anatomical structures especially within dense breasts in conjunction with the inherently low soft tissue contrast of absorption images compromises image quality. This can be overcome by phase-contrast imaging. Approach: We analyze the spatial resolution of grating-based multimodal mammography using a mammographic phantom and one freshly dissected mastectomy specimen at an inverse Compton x-ray source. Here, the focus was on estimating the spatial resolution with the sample in the beam path and discussing benefits and drawbacks of the method used and the estimation of the mean glandular dose. Finally, the possibility of improving the spatial resolution is investigated by comparing monochromatic grating-based mammography with the standard one. Results: The spatial resolution is constant or also higher for the image acquired with monochromatic radiation and the contrast-to-noise ratio (CNR) is higher in our approach while the dose can be reduced by up to 20%. Conclusions: In summary, phase-contrast imaging helps to improve tumor detection by advanced diagnostic image quality. We demonstrate a higher spatial resolution for one mastectomy specimen and increased CNR at an equal or lower dose for the monochromatic measurements.
Collapse
Affiliation(s)
- Lisa Heck
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Elena Eggl
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Susanne Grandl
- Ludwig Maximilian University of Munich, Institute for Clinical Radiology, Munich, Germany
| | - Martin Dierolf
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Christoph Jud
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Benedikt Günther
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Klaus Achterhold
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Doris Mayr
- Ludwig Maximilian University of Munich, Institute of Pathology, Munich, Germany
| | - Bernhard Gleich
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| | - Karin Hellerhoff
- Ludwig Maximilian University of Munich, Institute for Clinical Radiology, Munich, Germany
| | - Franz Pfeiffer
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany.,Technical University of Munich, School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Julia Herzen
- Technical University of Munich, Chair of Biomedical Physics, Munich School of BioEngineering, Department of Physics, Garching, Germany
| |
Collapse
|
4
|
Müller-Schimpfle M, Bader W, Baltzer P, Bernathova M, Fuchsjäger M, Golatta M, Helbich TH, Hellerhoff K, Heywang-Köbrunner SH, Kurtz C, Mundinger A, Siegmann-Luz KC, Skaane P, Solbach C, Weigel S. Consensus Meeting of Breast Imaging: BI-RADS® and Beyond. Breast Care (Basel) 2019; 14:308-314. [PMID: 31798391 DOI: 10.1159/000503412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/17/2019] [Indexed: 11/19/2022] Open
Abstract
Organizers of medical educational courses are often confronted with questions that are clinically relevant yet trespassing the frontiers of scientifically proven, evidence-based medicine at the point of care. Therefore, since 2007 organizers of breast teaching courses in German language met biannually to find a consensus in clinically relevant questions that have not been definitely answered by science. The questions were prepared during the 3 months before the meeting according to a structured process and finally agreed upon the day before the consensus meeting. At the consensus meeting, the open questions concerning 2D/3D mammography, breast ultrasound, MR mammography, interventions as well as risk-based imaging of the breast were presented first for electronic anonymized voting, and then the results of the audience were separately displayed from the expert votes. Thereafter, an introductory statement of the moderator was followed by pros/cons of two experts, and subsequently the final voting was performed. With ≥75% of votes of the expert panel, an answer qualified as a consensus statement. Seventeen consensus statements were gained, addressing for instance the use of 2D/3D mammography, breast ultrasound in screening, MR mammography in women with intermediate breast cancer risk, markers for localization of pathologic axillary lymph nodes, and standards in risk-based imaging of the breast. After the evaluation, comments from the experts on each field were gathered supplementarily. Methodology, transparency, and soundness of statements achieve a unique yield for all course organizers and provide solid pathways for decision making in breast imaging.
Collapse
Affiliation(s)
- Markus Müller-Schimpfle
- Clinic of Radiology, Neuroradiology, and Nuclear Medicine, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | - Werner Bader
- Department of Gynecology and Obstetrics, Klinikum Bielefeld, Bielefeld, Germany
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna and General Hospital, Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna and General Hospital, Vienna, Austria
| | | | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna and General Hospital, Vienna, Austria
| | - Karin Hellerhoff
- Department of Diagnostic Radiology, Rotkreuzklinikum München, Munich, Germany
| | | | - Claudia Kurtz
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alexander Mundinger
- Department of Radiology, Niels-Stensen-Kliniken, Marienhospital Osnabrück GmbH, Osnabrück, Germany
| | | | - Per Skaane
- Department of Radiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Chistine Solbach
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefanie Weigel
- Institute of Clinical Radiology, Medical Faculty and University Hospital Münster, Münster, Germany
| |
Collapse
|
5
|
Hellerhoff K, Birnbacher L, Sztrókay-Gaul A, Grandl S, Auweter S, Willner M, Marschner M, Mayr D, Reiser MF, Pfeiffer F, Herzen J. Assessment of intraductal carcinoma in situ (DCIS) using grating-based X-ray phase-contrast CT at conventional X-ray sources: An experimental ex-vivo study. PLoS One 2019; 14:e0210291. [PMID: 30625220 PMCID: PMC6326478 DOI: 10.1371/journal.pone.0210291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The extent of intraductal carcinoma in situ (DCIS) is commonly underestimated due to the discontinuous growth and lack of microcalcifications. Specimen radiography has been established to reduce the rate of re-excision. However, the predictive value for margin assessment with conventional specimen radiography for DCIS is low. In this study we assessed the potential of grating-based phase-contrast computed tomography (GBPC-CT) at conventional X-ray sources for specimen tomography of DCIS containing samples. MATERIALS AND METHODS GBPC-CT was performed on four ex-vivo breast specimens containing DCIS and invasive carcinoma of non-specific type. Phase-contrast and absorption-based datasets were manually matched with corresponding histological slices as the standard of reference. RESULTS Matching of CT images and histology was successful. GBPC-CT showed an improved soft tissue contrast compared to absorption-based images revealing more histological details in the same sections. Non-calcifying DCIS exceeding the invasive tumor could be correlated to areas of dilated bright ducts around the tumor. CONCLUSIONS GBPC-CT imaging at conventional X-ray sources offers improved depiction quality for the imaging of breast tissue samples compared to absorption-based imaging, allows the identification of diagnostically relevant tissue details, and provides full three-dimensional assessment of sample margins.
Collapse
MESH Headings
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- In Vitro Techniques
- Mammography/methods
- Microscopy, Phase-Contrast/methods
- Prospective Studies
- Tomography, X-Ray Computed/methods
Collapse
Affiliation(s)
- Karin Hellerhoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Lorenz Birnbacher
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Susanne Grandl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Sigrid Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Marian Willner
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Mathias Marschner
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| |
Collapse
|
6
|
Eggl E, Grandl S, Sztrόkay-Gaul A, Dierolf M, Jud C, Heck L, Burger K, Günther B, Achterhold K, Mayr D, Wilkens JJ, Auweter SD, Gleich B, Hellerhoff K, Reiser MF, Pfeiffer F, Herzen J. Dose-compatible grating-based phase-contrast mammography on mastectomy specimens using a compact synchrotron source. Sci Rep 2018; 8:15700. [PMID: 30356116 PMCID: PMC6200806 DOI: 10.1038/s41598-018-33628-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/29/2018] [Indexed: 01/25/2023] Open
Abstract
With the introduction of screening mammography, the mortality rate of breast cancer has been reduced throughout the last decades. However, many women undergo unnecessary subsequent examinations due to inconclusive diagnoses from mammography. Two pathways appear especially promising to reduce the number of false-positive diagnoses. In a clinical study, mammography using synchrotron radiation was able to clarify the diagnosis in the majority of inconclusive cases. The second highly valued approach focuses on the application of phase-sensitive techniques such as grating-based phase-contrast and dark-field imaging. Feasibility studies have demonstrated a promising enhancement of diagnostic content, but suffer from dose concerns. Here we present dose-compatible grating-based phase-contrast and dark-field images as well as conventional absorption images acquired with monochromatic x-rays from a compact synchrotron source based on inverse Compton scattering. Images of freshly dissected mastectomy specimens show improved diagnostic content over ex-vivo clinical mammography images at lower or equal dose. We demonstrate increased contrast-to-noise ratio for monochromatic over clinical images for a well-defined phantom. Compact synchrotron sources could potentially serve as a clinical second level examination.
Collapse
Affiliation(s)
- Elena Eggl
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany.
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany.
| | - Susanne Grandl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, München, Germany
| | - Anikό Sztrόkay-Gaul
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, München, Germany
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| | - Christoph Jud
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| | - Lisa Heck
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| | - Karin Burger
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
- Max-Planck-Institute for Quantum Optics, Hans-Kopfermann-Straße 1, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-University München, Thalkirchner Straße 36, 80337, München, Germany
| | - Jan J Wilkens
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Sigrid D Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, München, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, München, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistraße 15, 81377, München, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Straße 1, 85748, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstraße 11, 85748, Garching, Germany
| |
Collapse
|
7
|
Hermelink K, Bühner M, Sckopke P, Neufeld F, Kaste J, Voigt V, Münzel K, Wuerstlein R, Ditsch N, Hellerhoff K, Rjosk-Dendorfer D, Braun M, von Koch FE, Härtl K, Hasmüller S, Bauerfeind I, Debus G, Herschbach P, Mahner S, Harbeck N. Chemotherapy and Post-traumatic Stress in the Causation of Cognitive Dysfunction in Breast Cancer Patients. J Natl Cancer Inst 2017; 109:3795524. [PMID: 28521364 DOI: 10.1093/jnci/djx057] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background Cancer-related cognitive dysfunction has mostly been attributed to chemotherapy; this explanation, however, fails to account for cognitive dysfunction observed in chemotherapy-naïve patients. In a controlled, longitudinal, multisite study, we tested the hypothesis that cognitive function in breast cancer patients is affected by cancer-related post-traumatic stress. Methods Newly diagnosed breast cancer patients and healthy control subjects, age 65 or younger, underwent three assessments within one year, including paper-and-pencil and computerized neuropsychological tests, clinical diagnostics of post-traumatic stress disorder (PTSD), and self-reported cognitive function. Analysis of variance was used to compare three groups of participants-patients who did or did not receive chemotherapy and healthy control subjects-on age- and education-corrected cognitive performance and cognitive change. Differences that were statistically significant after correction for false discovery rate were investigated with linear mixed-effects models and mediation models. All statistical tests were two-sided. Results Of 226 participants (166 patients and 60 control subjects), 206 completed all assessment sessions (attrition: 8.8%). Patients demonstrated overall cognitive decline (group*time effect on composite z -score: -0.13, P = .04) and scored consistently worse on Go/Nogo errors. The latter effect was mediated by PTSD symptoms (mediation effect: B = 0.15, 95% confidence interval = 0.02 to 0.38). Only chemotherapy patients showed declined reaction time on a computerized alertness test. Overall cognitive performance correlated with self-reported cognitive problems at one year ( T = -0.11, P = .02). Conclusions Largely irrespective of chemotherapy, breast cancer patients may encounter very subtle cognitive dysfunction, part of which is mediated by cancer-related post-traumatic stress. Further factors other than treatment side effects remain to be investigated.
Collapse
Affiliation(s)
- Kerstin Hermelink
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Markus Bühner
- CCCLMU University Hospital of Munich, Munich, Germany.,Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Philipp Sckopke
- CCCLMU University Hospital of Munich, Munich, Germany.,Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Franziska Neufeld
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Judith Kaste
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Varinka Voigt
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Karin Münzel
- Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Nina Ditsch
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Franz Edler von Koch
- Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany
| | - Kristin Härtl
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany.,Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany
| | - Stephan Hasmüller
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany.,Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany
| | - Ingo Bauerfeind
- Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany
| | - Gerlinde Debus
- Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany
| | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, CCC University Hospital of Munich, Germany
| |
Collapse
|
8
|
Coello E, Sperl JI, Bequé D, Benz T, Scherer K, Herzen J, Sztrókay-Gaul A, Hellerhoff K, Pfeiffer F, Cozzini C, Grandl S. Fourier domain image fusion for differential X-ray phase-contrast breast imaging. Eur J Radiol 2017; 89:27-32. [DOI: 10.1016/j.ejrad.2017.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/25/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
|
9
|
Voigt V, Neufeld F, Kaste J, Bühner M, Sckopke P, Wuerstlein R, Hellerhoff K, Sztrókay-Gaul A, Braun M, von Koch FE, Silva-Zürcher E, Hasmüller S, Bauerfeind I, Debus G, Herschbach P, Mahner S, Harbeck N, Hermelink K. Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psychooncology 2016; 26:74-80. [PMID: 26898732 DOI: 10.1002/pon.4102] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. METHODS Patients with stage 0-III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis. RESULTS Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. CONCLUSIONS Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Varinka Voigt
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Franziska Neufeld
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Judith Kaste
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Markus Bühner
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Philipp Sckopke
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Franz Edler von Koch
- Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany
| | - Eliane Silva-Zürcher
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Stephan Hasmüller
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany.,Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany
| | - Ingo Bauerfeind
- Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany
| | - Gerlinde Debus
- Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany
| | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Kerstin Hermelink
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| |
Collapse
|
10
|
Gromann LB, Bequé D, Scherer K, Willer K, Birnbacher L, Willner M, Herzen J, Grandl S, Hellerhoff K, Sperl JI, Pfeiffer F, Cozzini C. Low-dose, phase-contrast mammography with high signal-to-noise ratio. Biomed Opt Express 2016; 7:381-391. [PMID: 26977347 PMCID: PMC4771456 DOI: 10.1364/boe.7.000381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/19/2015] [Accepted: 12/20/2015] [Indexed: 06/05/2023]
Abstract
Differential phase-contrast X-ray imaging using a Talbot-Lau interferometer has recently shown promising results for applications in medical imaging. However, reducing the applied radiation dose remains a major challenge. In this study, we consider the realization of a Talbot-Lau interferometer in a high Talbot order to increase the signal-to-noise ratio for low-dose applications. The quantitative performance of π and π/2 systems at high Talbot orders is analyzed through simulations, and the design energy and X-ray spectrum are optimized for mammography. It is found that operation even at very high Talbot orders is feasible and beneficial for image quality. As long as the X-ray spectrum is matched to the visibility spectrum, the SNR continuously increases with the Talbot order for π-systems. We find that the optimal X-ray spectra and design energies are almost independent of the Talbot order and that the overall imaging performance is robust against small variations in these parameters. Discontinuous spectra, such as that from molybdenum, are less robust because the characteristic lines may coincide with minima in the visibility spectra; however, they may offer slightly better performance. We verify this hypothesis by realizing a prototype system with a mean fringe visibility of above 40% at the seventh Talbot order. With this prototype, a proof-of-principle measurement of a freshly dissected breast at reasonable compression to 4 cm is conducted with a mean glandular dose of only 3 mGy but with a high SNR.
Collapse
Affiliation(s)
- Lukas B. Gromann
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
- GE Global Research, 85748 Garching,
Germany
| | - Dirk Bequé
- GE Global Research, 85748 Garching,
Germany
| | - Kai Scherer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | - Konstantin Willer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | - Lorenz Birnbacher
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | - Marian Willner
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | - Julia Herzen
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | - Susanne Grandl
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich,
Germany
| | - Karin Hellerhoff
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich,
Germany
| | | | - Franz Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, 85748 Garching,
Germany
| | | |
Collapse
|
11
|
Scherer K, Willer K, Gromann L, Birnbacher L, Braig E, Grandl S, Sztrókay-Gaul A, Herzen J, Mayr D, Hellerhoff K, Pfeiffer F. Toward Clinically Compatible Phase-Contrast Mammography. PLoS One 2015; 10:e0130776. [PMID: 26110618 PMCID: PMC4481352 DOI: 10.1371/journal.pone.0130776] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/22/2015] [Indexed: 11/18/2022] Open
Abstract
Phase-contrast mammography using laboratory X-ray sources is a promising approach to overcome the relatively low sensitivity and specificity of clinical, absorption-based screening. Current research is mostly centered on identifying potential diagnostic benefits arising from phase-contrast and dark-field mammography and benchmarking the latter with conventional state-of-the-art imaging methods. So far, little effort has been made to adjust this novel imaging technique to clinical needs. In this article, we address the key points for a successful implementation to a clinical routine in the near future and present the very first dose-compatible and rapid scan-time phase-contrast mammograms of both a freshly dissected, cancer-bearing mastectomy specimen and a mammographic accreditation phantom.
Collapse
Affiliation(s)
- Kai Scherer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
- * E-mail:
| | - Konstantin Willer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| | - Lukas Gromann
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| | - Lorenz Birnbacher
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| | - Eva Braig
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| | - Susanne Grandl
- Institute of Clinical Radiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anikó Sztrókay-Gaul
- Institute of Clinical Radiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Herzen
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karin Hellerhoff
- Institute of Clinical Radiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franz Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Munich, Germany
| |
Collapse
|
12
|
Grandl S, Sztrókay-Gaul A, Auweter SD, Hellerhoff K. [Phase contrast imaging of the breast. Basic principles and steps towards clinical implementation]. Radiologe 2014; 54:254-61. [PMID: 24623010 DOI: 10.1007/s00117-013-2577-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE Breast cancer is the most common cancer and the leading cause of cancer deaths in women worldwide. STANDARD RADIOLOGICAL METHODS Mammography is the only imaging technique approved for nationwide breast cancer screening. Digital full field mammography has improved mammographic image quality. Nevertheless, mammography has a low positive predictive value and a low sensitivity especially in mammographically dense breasts. One of the major limitations is the inherently low contrast between healthy breast parenchyma and breast cancer. METHODICAL INNOVATIONS Phase contrast imaging is based on the phase shift that occurs when X-rays encounter a change in refractive index between different materials. PERFORMANCE The improved soft tissue contrast makes the technology particularly promising for breast diagnostics. ACHIEVEMENTS The studies presented here suggest that phase contrast imaging provides additional diagnostic information both using phase contrast mammography and phase contrast computed tomography (CT). PRACTICAL RECOMMENDATIONS This paper provides an overview of the basic principles of the phase contrast imaging and describes recent developments towards in vivo and ex vivo phase contrast imaging of the breast.
Collapse
Affiliation(s)
- S Grandl
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
| | | | | | | |
Collapse
|
13
|
Abstract
CLINICAL/METHODICAL ISSUE Neoadjuvant chemotherapy is increasingly being applied in patients with operable breast cancer. Thus, an early prediction of response to neoadjuvant chemotherapy is of high relevance. STANDARD RADIOLOGICAL METHODS The interobserver variability of clinical examination, mammography and ultrasonography in the assessment of response to neoadjuvant chemotherapy is high. METHODICAL INNOVATIONS Magnetic resonance imaging (MRI) allows the assessment of functional parameters in addition to changes in tumor size and morphology. PERFORMANCE A reliable therapy response monitoring aims at optimizing individualized patient care. ACHIEVEMENTS This paper summarizes current guidelines for the assessment of response to neoadjuvant chemotherapy in breast cancer according to the response evaluation criteria in solid tumors (RECIST). Furthermore, the technical principles of MRI-based therapy monitoring are described and an overview of the clinical studies that have assessed the feasibility of functional MRI in response to treatment evaluation is given. PRACTICAL RECOMMENDATIONS The technology of functional MRI offers promising results concerning therapy response monitoring. However, the level of evidence is not sufficiently evaluated for the technologies of functional MRI presented here.
Collapse
Affiliation(s)
- S Grandl
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
| | | | | |
Collapse
|
14
|
Grandl S, Willner M, Herzen J, Sztrókay-Gaul A, Mayr D, Auweter SD, Hipp A, Birnbacher L, Marschner M, Chabior M, Reiser M, Pfeiffer F, Bamberg F, Hellerhoff K. Visualizing typical features of breast fibroadenomas using phase-contrast CT: an ex-vivo study. PLoS One 2014; 9:e97101. [PMID: 24824169 PMCID: PMC4019647 DOI: 10.1371/journal.pone.0097101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022] Open
Abstract
Background Fibroadenoma is the most common benign solid breast lesion type and a very common cause for histologic assessment. To justify a conservative therapy, a highly specific discrimination between fibroadenomas and other breast lesions is crucial. Phase-contrast imaging offers improved soft-tissue contrast and differentiability of fine structures combined with the potential of 3-dimensional imaging. In this study we assessed the potential of grating-based phase-contrast CT imaging for visualizing diagnostically relevant features of fibroadenomas. Materials and Methods Grating-based phase-contrast CT was performed on six ex-vivo formalin-fixed breast specimens containing a fibroadenoma and three samples containing benign changes that resemble fibroadenomas using Talbot Lau interferometry and a polychromatic X-ray source. Phase-contrast and simultaneously acquired absorption-based 3D-datasets were manually matched with corresponding histological slices. The visibility of diagnostically valuable features was assessed in comparison with histology as the gold-standard. Results In all cases, matching of grating-based phase-contrast CT images and histology was successfully completed. Grating-based phase-contrast CT showed greatly improved differentiation of fine structures and provided accurate depiction of strands of fibrous tissue within the fibroadenomas as well as of the diagnostically valuable dilated, branched ductuli of the fibroadenomas. A clear demarcation of tumor boundaries in all cases was provided by phase- but not absorption-contrast CT. Conclusions Pending successful translation of the technology to a clinical setting and considerable reduction of the required dose, the data presented here suggest that grating-based phase-contrast CT may be used as a supplementary non-invasive diagnostic tool in breast diagnostics. Phase-contrast CT may thus contribute to the reduction of false positive findings and reduce the recall and core biopsy rate in population-based screening. Phase-contrast CT may further be used to assist during histopathological workup, offering a 3D view of the tumor and helping to identify diagnostically valuable tissue sections within large tumors.
Collapse
Affiliation(s)
- Susanne Grandl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
- * E-mail:
| | - Marian Willner
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
- Institute for Materials Research, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Sigrid D. Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Alexander Hipp
- Institute for Materials Research, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - Lorenz Birnbacher
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
| | - Mathias Marschner
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
| | - Michael Chabior
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Franz Pfeiffer
- Department of Physics and Institute of Medical Engineering, Technical University of Munich, Munich, Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| |
Collapse
|
15
|
Scherer K, Birnbacher L, Chabior M, Herzen J, Mayr D, Grandl S, Sztrókay-Gaul A, Hellerhoff K, Bamberg F, Pfeiffer F. Bi-directional x-ray phase-contrast mammography. PLoS One 2014; 9:e93502. [PMID: 24824594 PMCID: PMC4019485 DOI: 10.1371/journal.pone.0093502] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/03/2014] [Indexed: 12/15/2022] Open
Abstract
Phase-contrast x-ray imaging is a promising improvement of conventional absorption-based mammography for early tumor detection. This potential has been demonstrated recently, utilizing structured gratings to obtain differential phase and dark-field scattering images. However, the inherently anisotropic imaging sensitivity of the proposed mono-directional approach yields only insufficient diagnostic information, and has low diagnostic sensitivity to highly oriented structures. To overcome these limitations, we present a two-directional x-ray phase-contrast mammography approach and demonstrate its advantages by applying it to a freshly dissected, cancerous mastectomy breast specimen. We illustrate that the two-directional scanning procedure overcomes the insufficient diagnostic value of a single scan, and reliably detects tumor structures, independently from their orientation within the breast. Our results indicate the indispensable diagnostic necessity and benefit of a multi-directional approach for x-ray phase-contrast mammography.
Collapse
Affiliation(s)
- Kai Scherer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
- * E-mail:
| | - Lorenz Birnbacher
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Michael Chabior
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Julia Herzen
- Centre for Materials and Coastal Research, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - Doris Mayr
- Department of Pathology, Ludwig Maximilian University, Munich, Germany
| | - Susanne Grandl
- Department of Clinical Radiology, Ludwig Maximilian University, Munich, Germany
| | - Anikó Sztrókay-Gaul
- Department of Clinical Radiology, Ludwig Maximilian University, Munich, Germany
| | - Karin Hellerhoff
- Department of Clinical Radiology, Ludwig Maximilian University, Munich, Germany
| | - Fabian Bamberg
- Department of Clinical Radiology, Ludwig Maximilian University, Munich, Germany
| | - Franz Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department & Institut für Medizintechnik, Technische Universität München, Garching, Germany
| |
Collapse
|
16
|
Willner M, Herzen J, Grandl S, Auweter S, Mayr D, Hipp A, Chabior M, Sarapata A, Achterhold K, Zanette I, Weitkamp T, Sztrókay A, Hellerhoff K, Reiser M, Pfeiffer F. Quantitative breast tissue characterization using grating-based x-ray phase-contrast imaging. Phys Med Biol 2014; 59:1557-71. [PMID: 24614413 DOI: 10.1088/0031-9155/59/7/1557] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
X-ray phase-contrast imaging has received growing interest in recent years due to its high capability in visualizing soft tissue. Breast imaging became the focus of particular attention as it is considered the most promising candidate for a first clinical application of this contrast modality. In this study, we investigate quantitative breast tissue characterization using grating-based phase-contrast computed tomography (CT) at conventional polychromatic x-ray sources. Different breast specimens have been scanned at a laboratory phase-contrast imaging setup and were correlated to histopathology. Ascertained tumor types include phylloides tumor, fibroadenoma and infiltrating lobular carcinoma. Identified tissue types comprising adipose, fibroglandular and tumor tissue have been analyzed in terms of phase-contrast Hounsfield units and are compared to high-quality, high-resolution data obtained with monochromatic synchrotron radiation, as well as calculated values based on tabulated tissue properties. The results give a good impression of the method's prospects and limitations for potential tumor detection and the associated demands on such a phase-contrast breast CT system. Furthermore, the evaluated quantitative tissue values serve as a reference for simulations and the design of dedicated phantoms for phase-contrast mammography.
Collapse
Affiliation(s)
- M Willner
- Department of Physics and Institute of Medical Engineering, Technische Universität München, James-Franck-Straße 1, D-85748 Garching, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Auweter SD, Herzen J, Willner M, Grandl S, Scherer K, Bamberg F, Reiser MF, Pfeiffer F, Hellerhoff K. X-ray phase-contrast imaging of the breast--advances towards clinical implementation. Br J Radiol 2014; 87:20130606. [PMID: 24452106 DOI: 10.1259/bjr.20130606] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer constitutes about one-quarter of all cancers and is the leading cause of cancer death in women. To reduce breast cancer mortality, mammographic screening programmes have been implemented in many Western countries. However, these programmes remain controversial because of the associated radiation exposure and the need for improvement in terms of diagnostic accuracy. Phase-contrast imaging is a new X-ray-based technology that has been shown to provide enhanced soft-tissue contrast and improved visualization of cancerous structures. Furthermore, there is some indication that these improvements of image quality can be maintained at reduced radiation doses. Thus, X-ray phase-contrast mammography may significantly contribute to advancements in early breast cancer diagnosis. Feasibility studies of X-ray phase-contrast breast CT have provided images that allow resolution of the fine structure of tissue that can otherwise only be obtained by histology. This implies that X-ray phase-contrast imaging may also lead to the development of entirely new (micro-) radiological applications. This review provides a brief overview of the physical characteristics of this new technology and describes recent developments towards clinical implementation of X-ray phase-contrast imaging of the breast.
Collapse
Affiliation(s)
- S D Auweter
- Department of Clinical Radiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Grandl S, Willner M, Herzen J, Mayr D, Auweter SD, Hipp A, Pfeiffer F, Reiser M, Hellerhoff K. Evaluation of phase-contrast CT of breast tissue at conventional X-ray sources - presentation of selected findings. Z Med Phys 2013; 23:212-21. [PMID: 23489931 DOI: 10.1016/j.zemedi.2013.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Grating-based phase contrast computed tomography (PC-CT) at synchrotron radiation sources has been shown to provide improved visualization of breast tumors. However, broad clinical application of phase-contrast imaging will likely depend on transferring the technology to standard polychromatic X-ray sources. On the basis of selected findings, we demonstrate the potential of grating-based PC-CT using a conventional X-ray source. MATERIALS AND METHODS Grating-based PC-CT of two ex-vivo formalin fixed breast specimens containing lobular carcinoma was conducted using a Talbot Lau interferometer run at a polychromatic X-ray source of 40kVp. Phase-contrast and absorption-based 3D-datasets of both specimens were simultaneously recorded. Radiological images were manually matched with corresponding histological sections. The visualization of selected histological findings in phase contrast was compared to absorption contrast. RESULTS Grating-based PC-CT was able to depict the 3-dimensional structure of dilated ducts and high phase contrast was found as a correlate to thickened fibrous ductal walls. Differences in contrast between fibrous and less fibrous breast tissue were observed in phase- but not in absorption-contrast images. Furthermore, regions of low phase contrast correlated with the extension of compact tumor components. CONCLUSIONS On the basis of selected findings, we show that grating-based PC-CT at a polychromatic X-ray source provides complementary information to conventional absorption contrast; albeit at lower spatial resolution than synchrotron-based imaging.
Collapse
Affiliation(s)
- Susanne Grandl
- Department of Clinical Radiology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Liebhardt S, Willner M, Herzen J, Mayr D, Auweter SD, Reiser M, Hellerhoff K. Fortschritte in der Brustdiagnostik mittels gitterbasierter Phasenkontrastbildgebung. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1329777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Johnson TRC, Himsl I, Hellerhoff K, Mayr D, Rjosk-Dendorfer D, Ditsch N, Krauss B, Friese K, Reiser MF, Lenhard MS. Dual-energy CT for the evaluation of silicone breast implants. Eur Radiol 2012; 23:991-6. [PMID: 23064715 DOI: 10.1007/s00330-012-2667-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/28/2012] [Accepted: 09/08/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The evaluation of breast implants for rupture is currently the domain of ultrasound and MRI, while mammography is of very limited diagnostic value. Recently, specific visualisation of silicone has become feasible using dual-energy CT. Our objective was to evaluate whether it is feasible to identify silicone in breast implants by dual-energy CT and to reliably diagnose or rule out ruptures. METHODS Seven silicone breast implant specimens were examined on dual-source CT at 100- and 140-kV tube potential with a 0.8-mm tin filter (collimation 128 × 0.6 mm, current-time products 165 and 140 mAsref with modulation, rotation time 0.28 s, pitch 0.55). Two patients scheduled for implant removal or replacement were examined with identical parameters. RESULTS The silicone of the implant specimens showed a strong dual-energy signal. In one patient, both implants were intact, while a rupture was identified in the other patient. Ultrasound, MRI, surgical findings and histology confirmed the dual-energy CT diagnosis. CONCLUSION Dual-energy CT may serve as an alternative technique for speedy evaluation of silicone breast implants. Specific clinical studies are required to determine the diagnostic accuracy and define indications for this technique.
Collapse
Affiliation(s)
- Thorsten R C Johnson
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Marchioninistr. 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
The primary focus of the establishment and certification of specialized cancer centers in the context of the National Cancer Plan is to improve the quality of care for patients with various carcinoma entities. The era of organ center certification started with the establishment of specialized breast cancer centers in line with the high incidence of breast cancer, the high mortality rate and the high level of interdisciplinary cooperation in the diagnosis and therapy of breast cancer. The introduction of quality management and external monitoring aims to provide high quality care in the diagnosis and therapy of breast cancer and is expected to improve long-term quality data (disease-free survival and overall survival) and to reduce mortality rates by about 25-30%. Certification requires the implementation of a quality management system and care provision structures assuring diagnosis and therapy according to the quality guidelines and recommendations of the specialist societies. Basic requirements for improving the quality of breast cancer patient care are centralization, specialization and interdisciplinarity. It has been demonstrated that the improvement of overall survival is associated with an increasing annual case load of a center, an increasing case load per surgeon per year, study participation and interdisciplinarity. Tumor documentation will be harmonized in the future by the establishment of local clinical cancer registries and cross-linking them with the National Cancer Registry. The data collection and analysis of several quality markers and current follow-up and survival data for each breast cancer patient will allow direct comparison of participating institutions. Individual breast cancer centers may demonstrate quality improvement longitudinally. Both certification and specialization require additional services which are associated with a substantial increase in costs. Preliminary data suggest that certified breast cancer centers are dependent on cross-financing by the participating departments of a hospital. Up to now cost-effective analyses for certified breast cancer centers are not available due to a substantial lack of data defining the additional financial burden.
Collapse
Affiliation(s)
- K Hellerhoff
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
22
|
|
23
|
Heywang-Köbrunner SH, Heinig A, Hellerhoff K, Holzhausen HJ, Nährig J. Use of ultrasound-guided percutaneous vacuum-assisted breast biopsy for selected difficult indications. Breast J 2009; 15:348-56. [PMID: 19500104 DOI: 10.1111/j.1524-4741.2009.00738.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To assess ultrasound-guided vacuum-assisted biopsy (US-VAB) for selected problem cases and to report experiences with two different biopsy systems. Fifty-one lesions have been biopsied using the Mammotome (n = 24) or the Vacora (n = 27) system. Main indications: lesion in scarring (n = 5), complex cystic >or=8 mm (n = 7), increase in size (n = 10), architectural distortion (n = 4), uncharacteristic palpable abnormality (2), small size (n = 22), regional microcalcifications (n = 1). Results are verified by surgical excision (n = 10) or follow-up (n = 40). One patient was lost to follow-up. In four of the cases preceding core biopsy was inconclusive. four invasive carcinomas, two ductal carcinoma in situ (DCIS), three papillomas, six fibroadenomas, one adenosis tumor, one hamartoma, 10 complex cysts, 16 benign changes, three fat necroses, two granulomas, three unspecific inflammatory changes are verified. Surgery confirmed five malignancies, four benign changes, and converted one uncertain diagnosis (architectural distortion) from "inflammatory" to DCIS. Documented removal of all or most of the lesions correctly increased the level of confidence and open surgery could be avoided in 41/51 lesions. The two systems show different advantages and drawbacks. US-VAB may improve the level of confidence in selected difficult cases. Careful case selection and systematic retrospective correlation of imaging and histology remain crucial.
Collapse
Affiliation(s)
- Sylvia H Heywang-Köbrunner
- Center for Breast Diagnosis, Radiologie Haidhausen, Reference Center for Mammography Munich, Munich, Germany.
| | | | | | | | | |
Collapse
|
24
|
Heywang-Köbrunner S, Artmann A, Hellerhoff K. Breast cancer diagnosis — when is MRI indicated? EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
|
26
|
Heywang-Köbrunner S, Hellerhoff K, Artmann A. Conventional Film versus Digital Mammography Breast Cancer Screening: Pros and Cons. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Rösch T, Meining A, Frühmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K, Classen M, Helmberger H. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 2002; 55:870-6. [PMID: 12024143 DOI: 10.1067/mge.2002.124206] [Citation(s) in RCA: 237] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The differential diagnosis of biliary strictures remains a challenge. This study evaluated magnetic resonance cholangiopancreatography (MRCP) as a new procedure in comparison with the established methods of diagnosis including ERCP or percutaneous transhepatic cholangiography (PTC), CT, and EUS. METHODS Fifty patients (21 men, 29 women, mean age 65.7 years) with jaundice but no pain suspected to have biliary strictures were enrolled in this prospective study. MRCP, ERCP/PTC, CT, and EUS were performed prospectively; images and videotapes (EUS) of these tests were reviewed blindly under standardized conditions. Reference standards for comparison were surgery, a biopsy confirming malignancy, or the clinical course during follow-up (at least 12 months) in cases without histopathologic proof of malignancy. RESULTS Seven patients ultimately proved to have jaundice caused by parenchymal liver disease and 43 had a biliary stricture (17 benign, 26 malignant). Forty patients underwent all 4 imaging tests. There were 10 patients in whom patient-specific problems precluded some procedures but who were included in an intention-to-diagnose analysis. The sensitivity and specificity for diagnosis of malignancy in the 50 patients were as follows: 85% / 75% for ERCP/PTC, 85% / 71% for MRCP, 77% / 63% for CT, and 79% / 62% for EUS, with similar values in the 40 patients who underwent all 4 imaging methods. The combination of MRCP and EUS improved specificity. CONCLUSIONS Although MRCP provides the same imaging information as direct cholangiography, it has limited specificity for the diagnosis of malignant strictures. In the differential diagnosis of biliary strictures, several tests including ERCP-guided tissue diagnosis are still required, and MRCP has only a limited clinical role.
Collapse
Affiliation(s)
- Thomas Rösch
- Department of Internal Medicine II, Technical University of Munich, Munich, Germany
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Helmberger H, Hellerhoff K, Rüll T, Sorger N, Rösch T. [Radiologic diagnosis of the gallbladder and bile ducts. 2: Extra- and intrahepatic obstruction, value of diagnostic methods]. Radiologe 2001; 41:804-15; quiz 816-7. [PMID: 11593806 DOI: 10.1007/s001170170096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H Helmberger
- Abteilung Diagnostische und Interventionelle Radiologie/Nuklearmedizin, Krankenhaus Dritter Orden, Menzingerstrasse 44, 80638 München.
| | | | | | | | | |
Collapse
|
29
|
Helmberger H, Hellerhoff K, Rüll T, Sorger N, Rösch T. [Radiologic diagnosis of the gallbladder and bile ducts. 1: Imaging methods, normal anatomy and anatomic variants]. Radiologe 2001; 41:711-21; quiz 722-3. [PMID: 11552387 DOI: 10.1007/s001170170125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Helmberger
- Abteilung Diagnostische und Interventionelle Radiologie/Nuklearmedizin, Krankenhaus Dritter Orden München-Nymphenburg, Menzingerstr. 44, 80638 München.
| | | | | | | | | |
Collapse
|
30
|
Abstract
Chronic inflammation of the gallbladder and the biliary tract due to infections are rare, compared to common cholelithiasis and acute biliary inflammation. This group of diseases includes, besides of chronic cholecystitis with cholelithiasis, also chronic gallbladder inflammation without stones, gallbladder hydrops and porcelain gallbladder. The most common form of chronic biliary tract infection is primary sclerosing cholangitis, while infection due to parasites like oriental cholangiohepatitis is very rare in Europe. Using imaging modalities like ultrasonography, computed tomography and magnetic resonance imaging, normally, besides of porcelain gallbladder, only indirect signs of the disease may be documented. However, when i.v. cholangiography, endoscopic-retrograde cholangiography, percutaneous transhepatic cholangiography or MR-cholangiography are performed, depiction, especially of the biliary tree, is feasible. Differentiation of benign stricture and malignant tumor stenosis is problematic unrelated to the imaging modality used. Due to the unspecific signs of the disease, diagnosis may not be made from imaging alone, but a clinical suspicion may be strengthened.
Collapse
Affiliation(s)
- H Helmberger
- Institut für Röntgendiagnostik, Klinikum rechts der Isar, Technische Universität München.
| | | | | | | |
Collapse
|
31
|
Helmberger H, Hellerhoff K, Rüll T, Brandt C, Gerhardt P. [Functional MR-pancreatography with secretin. A comparison of imaging quality and diagnostic value]. ROFO-FORTSCHR RONTG 2000; 172:367-73. [PMID: 10961222 DOI: 10.1055/s-2000-332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The aim of the present study was to assess imaging improvement and diagnostic value of secretin stimulated MR-pancreatography (MRP) compared to conventional MRP. MATERIALS AND METHODS 50 patients were studied with a 1.0 T system using a single-shot-TSE sequence (RARE). Imaging quality and diameter of the different parts of the pancreatic tract and diagnoses were monitored before and after secretin. RESULTS The visualization of the normal main pancreatic duct (MPD) was improved significantly in head, body and tail. Side branches were not depicted at all. Even in chronic pancreatitis a significant improvement of imaging quality could be observed, but only in patients without duct dilation before secretin. In advanced disease with duct dilation, secretin stimulation provided no further diagnostic improvement. CONCLUSIONS In conclusion, secretin increases the diagnostic value of MRP especially in patients with normal or non-dilated native MPD and may help to avoid unnecessary invasive procedures such as ERCP.
Collapse
Affiliation(s)
- H Helmberger
- Technische Universität München, Klinikum rechts der Isar, Institut für Röntgendiagnostik.
| | | | | | | | | |
Collapse
|