Contrast-enhanced digital mammography

Clinical Imaging 33 (2009) 330 – 333 Abstracts Evaluation of white matter damage in patients with Alzheimer's Disease and in patients with mild cognitive impairment by using diffusion tensor imaging Ukmar M, Makuc E, Onor ML, Garbin G, Trevisiol M, Cova MA (U.C.O. di Radiologia, Universita' di Trieste, Ospedale di Cattinara, Strada di Fiume 447, I-34149 Trieste, Italy). Radiol med 2008;113:915–922. Purpose: The objective of this study was to evaluate white matter tissue damage in patients with Alzheimer's disease (AD) and in patients with mild cognitive impairment (MCI) using diffusion tensor imaging (DTI). Materials and Methods: Forty-seven subjects were evaluated: 14 patients with AD, 15 with MCI, and 18 healthy volunteers. All subjects were studied using conventional magnetic resonance imaging and DTI (32 directions) with a 1.5-T magnet. Fractional anisotropy (FA) was measured in the following regions: frontal, occipital, parietal, and temporal white matter and in the genu and splenium of the corpus callosum. The results were compared between the different groups and correlated with the Mini-Mental State Evaluation (MMSE) scores. Results: A statistically significant difference was obtained between controls and MCI patients (Pb.007) and between controls and AD patients (Pb.05) with regard to FA of the white matter in the splenium. A statistically significant difference was obtained between controls and AD patients with regard to FA in the genu (Pb.016). Moreover, there was a statistically significant difference between controls and AD patients considering the genu (Pb.016) and the frontal white matter on the right side (Pb.024). The MMSE scores correlated with the FA values measured in the genu, the splenium, and frontal white matter on the right side. No significant differences were identified between patients with AD and those with MCI. Conclusions: DTI could be of value in the early detection of white-matter damage in patients with MCI and AD. The DTI values correlate with the neuropsychological tests. Tissue characterization of head and neck lesions using diffusion-weighted MR imaging with SPLICE Sakamoto J, Yoshino N, Okochi K, Imaizumi A, Tetsumura A, Kurohara K, Kurabayashi T (Oral & Multiracial Radiology, Graduate School, Tokyo Medical & Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8549, Japan). Eur J Radiol 2008;69:260–268. Purpose: The purpose of this study was to evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging with split acquisition of fast spin-echo signals (SPLICE) in the tissue characterization of head and neck mass lesions. Patients and Methods: DW MR images of 67 head and neck mass lesions were obtained using SPLICE with b-factors of 0 and 771 s/mm2. The lesions were classified into three categories: 16 cysts, 32 benign tumors, and 19 malignant tumors. After ADC maps were constructed for all lesions, ADC values were calculated and compared among the three categories. 0899-7071/09/$ – see front matter Results: No case showed severe image distortion on DW MR imaging with SPLICE, and reliable ADC maps and ADC values were obtained in all cases. The mean ADC value of cysts was 2.41±0.48×10-3 mm2/s, which was significantly higher than that of benign (1.48±0.62×10−3 mm2/s) and malignant (1.23±0.45×10−3 mm2/s) tumors (Pb.001). However, there was no significant difference between the ADC values of benign and malignant tumors (P=.246). When an ADC value of 2.10×10−3 mm2/s or higher was used as the diagnostic criterion for cysts, the sensitivity, specificity, and accuracy were 94%, 88%, and 90%, respectively. Conclusion: SPLICE was considered a recommended DW MR imaging technique for the head and neck. Although ADC values were useful in differentiating cysts from tumors, they contributed little in predicting malignancy. Contribution of sonoelastography to the characterization of breast lesions Vanhoutte A, Fellah L, Galant C, d'Hoore W, Berlière M, Leconte I (Dpt Imagerie Médicale, Cliniques Universitaire St. Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium). J Belge Radiol 2008;91:187–194. We evaluate the performances of sonoelastography in the characterization of breast nodules with histologic correlation. Elastosonography was performed immediately after mode B sonography in 59 patients (65 nodules) by two radiologists, independently. All sequences of elastosonography were recorded. An intra- and interobservers correlation was calculated. Each nodule was classified with Breast Imaging Reporting and Data System (BI-RADS) lexicon and with Ueno elastography classification. The scores 1–3 were considered as benign and 4–5 as malignant. A cytologic/histologic diagnosis was available for all nodules. At histology, 16 nodules were malignant and 49 nodules were benign. The intra- and interobserver correlations of elastosonography were excellent. The sensitivity, specificity, positive predictive value, and negative predictive value of sonoelastography were 87.5%, 98%, 93.3%, and 96%, respectively, compared with 100%, 93.9%, 84%, and 100% of Mode B sonography. Thus, 95% (36/38 nodules) of BI-RADS 3 nodules were reclassified as scores 2 or 1 with elastosonography, decreasing the rates of fine needle aspiration and short-term follow-up. Elastosonography is a simple, rapid and complementary method to mode B sonography that can improve the specificity in the characterization of breast nodules and the management of BI-RADS 3 nodules, leading to a decrease of false-positive and short term follow-up rates. Contrast-enhanced digital mammography Dromain C, Balleyguier C, Adler G, Garbay JR, Delaloge S (Department of Radiology, Institut Gustave Roussy, 39, rue Camille Desmoulins, F-94805 Villejuf Cedex, France). Eur J Radiol 208;69:34–42. Abstracts / Clinical Imaging 33 (2009) 330–333 Contrast-enhanced digital mammography (CEDM) is a recent development of digital mammography using the intravenous injection of an iodinated contrast agent in conjunction with a mammography examination. Two techniques have been developed to perform CEDM examinations: the temporal subtraction technique with acquisition of high-energy images before and after contrast medium injection and the dual energy technique with acquisition of a pair of low- and high-energy images only after contrast medium injection. The temporal subtraction technique offered the possibility to analyze the kinetic curve of enhancement of breast lesions, similarly to breast magnetic resonance imaging. The dual energy technique do not provide information about the kinetic of tumor enhancement but allows the acquisition of multiples views of the same breast or bilateral examination and is less sensitive to patient motion than temporal CEDM. Initial clinical experience has shown the ability of CEDM to map the distribution of neovasculature induced by cancer using mammography. Moreover, previous studies have shown a superiority of MX+CEDM, either for the assessment of the probability of malignancy than for BI-RADS assessment comparing to MX alone. The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, particularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease, and the monitoring of the response to chemotherapy. CEDM should result in a simple way to enhance the detection and the characterization of breast lesions. Dynamic optical breast imaging: a novel technique to detect and characterize tumor vessels Fournier LS, Vanel D, Athanasiou A, Gatzemier W, Masuykov IV, Padhani AR, Dromain C, Galetti K, Sigal R, Costa A, Balleyguier C (Université de Paris Descartes, Hôpital Européen Georges Pompidou, Radiology Dept., 20 rue Leblanc, F-75015, France). Eur J Radiol 2009;69:43–49. Purpose: To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3–5 breast lesions. Materials and Methods: Forty-six patients with BI-RADS classification 3 (11%), 4 (44%), or 5 (44%) lesions underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy. Results: Optical mammography showed a statistical difference in numbers of suspect pixels between benign (n=12) and malignant (n=35) lesions (respectively, 1325 vs. 3170, P=.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status, or histological type of lesions. Conclusion: Optical imaging is a low-cost, noninvasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging. New potential and applications of contrast-enhanced ultrasound of the breast; own investigations and review of the literature Balleyguier C, Opolon P, Mathieu MC, Athanasiou A, Garbay JR, Delaloge S, Dromain C (Radiology Department, Institut Gustave Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif Cedex, France). Eur J Radiol 2008;69:14–23. Imaging of angiogenesis is a challenge for modern imaging. Velocimetry in malignant breast lesions and density of malignant vessels are very low. In breast imaging, first results of contrast-enhanced ultrasound were disappointing. Microbubbles are fragile when examined with high frequency 331 US, commonly used in breast imaging. Second-generation contrast agents increase intensively the signal level of breast lesions and new sequences like coherence pulse sequencing might be accurate to detect malignant vessels in breast lesions for characterization, to assess the extent of infiltrative breast carcinoma or to evaluate the tumor response after chemotherapy. Another interesting clinical application is the differentiation between post-operative changes and recurrences. In this review, we detail the main results obtained with contrast ultrasonography in a characterization study. In malignant lesions, enhancement was fast, starting with less than 20 s. Compared to magnetic resonance, enhancement appeared faster. Malignant vessels were predominant in the external ring of the nodule, conversely vessels were seen in the center of the lesion in benign nodules. Malignant vessels were also seen outside the lesion. This knowledge could lead the surgeon to perform a larger lumpectomy in these cases, to obtain sane margins and to reduce recurrences. Signal intensity of normal breast tissue at MR mammography midfield: applying a random coefficient model evaluating the effect of doubling the contrast dose Marklund M, Christensen R, Torp-Pedersen S, Thomsen C, Nolsøe CP (The Parker Institute, Frederiksberg Hospital, Ndr. Fasanvej 57-59, DK-2000 Frederisberg, Denmark). Eur J Radiol 2009;69:93–101. Purpose: To prospectively investigate the effect on signal intensity (SI) of healthy breast parenchyma on magnetic resonance mammography (MRM) when doubling the contrast dose from 0.1 to 0.2 mmol/kg body weight. Materials and Methods: Informed consent and institutional review board approval were obtained. Twenty-five healthy female volunteers [median age: 24 years (range: 21–37 years) and median bodyweight: 65 kg (51–80 kg)] completed two dynamic MRM examinations on a 0.6-T open scanner. The inter-examination time was 24 h (23.5–25 h). The following sequences were applied: axial T2W TSE and an axial dynamic T1W FFED, with a total of seven frames. At Day 1, an iv gadolinium bolus injection of 0.1 mmol/kg bodyweight (Omniscan) (low) was administered. On Day 2, the contrast dose was increased to 0.2 mmol/kg (high). Injection rate was 2 ml/s (Day 1) and 4 ml/s (Day 2). Any use of estrogen containing oral contraceptives (ECOC) was recorded. Postprocessing with automated subtraction, manually traced region of interest, and recording of the SI was performed. A random coefficient model was applied. Results: We found an SI increase of 24.2% and 40% following the low and high dose, respectively (Pb.0001), corresponding to a 65% (95% CI: 37– 99%) SI increase, indicating a moderate saturation. Although not statistically significant (P=.06), the results indicated a tendency, towards lower maximal SI in the breast parenchyma of ECOC users compared to non-ECOC users. Conclusion: We conclude that the contrast dose can be increased from 0.1 to 0.2 mmol/kg bodyweight, if a better contrast/noise relation is desired, but increasing the contrast dose above 0.2 mmol/kg body weight is not likely to improve the enhancement substantially due to the moderate saturation observed. Further research is needed to determine the impact of ECOC on the relative enhancement ratio, and further studies are needed to determine if a possible use of ECOC should be considered a compromising factor, if an MRM is indicated in a young woman. The importance of preoperative breast MRI for patients newly diagnosed with breast cancer Crowe JP, Patrick RJ, Rim A (9500 Euclid Ave. A80, Cleveland, OH 44195). Breast J 2008;15:52–60. The use of preoperative breast magnetic resonance imaging (bMRI) for patients newly diagnosed with breast cancer has been criticized for increasing the number of therapeutic mastectomies performed, as well as increasing the cost of treatment. The purpose of this report is to examine one surgeon's practice and to describe the MRI findings for patients with breast cancer to determine if those findings changed the therapeutic options for