Intraindividual, randomized comparison of the macrocyclic contrast agents gadobutrol and gadoterate meglumine in breast magnetic resonance imaging.

OBJECTIVES: To compare intraindividually two macrocyclic contrast agents - gadobutrol and gadoterate meglumine (Gd-DOTA) - for dynamic and quantitative assessment of relative enhancement (RE) in benign and malignant breast lesions. METHODS: This was an ethically approved, prospective, single-centre, randomized, crossover study in 52 women with suspected breast lesions referred for magnetic resonance imaging (MRI). Each patient underwent one examination with gadobutrol and one with Gd-DOTA (0.1 mmol/kg BW) on a 1.5 T system 1 - 7 days apart. Dynamic, T1-weighted, 3D gradient echo sequences were acquired under identical conditions. Quantitative evaluation with at least three regions of interest (ROI) per lesion was performed. Primary endpoint was RE during the initial postcontrast phase after the first and second dynamic acquisition, and peak RE. All lesions were histologically proven; differences between the examinations were evaluated. RESULTS: Forty-five patients with a total of 11 benign and 34 malignant lesions were assessed. Mean RE was significantly higher for gadobutrol than Gd-DOTA (p < 0.0001). Gadobutrol showed significantly less washout (64.4 %) than Gd-DOTA (75.4 %) in malignant lesions (p = 0.048) CONCLUSIONS: Gadobutrol has higher RE values compared with Gd-DOTA, whereas Gd-DOTA shows more marked washout in malignant lesions. This might improve the detection of breast lesions and influence the specificity of breast MRI-imaging.

Response to neoadjuvant treatment of invasive ductal breast carcinomas including outcome evaluation: MRI analysis by an automatic CAD system in comparison to visual evaluation.

BACKGROUND: The aim of this study was to evaluate imaging-based response to standardized neoadjuvant chemotherapy (NACT) regimen by dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM), whereas MR images were analyzed by an automatic computer-assisted diagnosis (CAD) system in comparison to visual evaluation. MRI findings were correlated with histopathologic response to NACT and also with the occurrence of metastases in a follow-up analysis. PATIENTS AND METHODS: Fifty-four patients with invasive ductal breast carcinomas received two identical MRI examinations (before and after NACT; 1.5T, contrast medium gadoteric acid). Pre-therapeutic images were compared with post-therapeutic examinations by CAD and two blinded human observers, considering morphologic and dynamic MRI parameters as well as tumor size measurements. Imaging-assessed response to NACT was compared with histopathologically verified response. All clinical, histopathologic, and DCE-MRM parameters were correlated with the occurrence of distant metastases. RESULTS: Initial and post-initial dynamic parameters significantly changed between pre- and post-therapeutic DCE-MRM. Visually evaluated DCE-MRM revealed sensitivity of 85.7%, specificity of 91.7%, and diagnostic accuracy of 87.0% in evaluating the response to NACT compared to histopathology. CAD analysis led to more false-negative findings (37.0%) compared to visual evaluation (11.1%), resulting in sensitivity of 52.4%, specificity of 100.0%, and diagnostic accuracy of 63.0%. The following dynamic MRI parameters showed significant associations to occurring metastases: Post-initial curve type before NACT (entire lesions, calculated by CAD) and post-initial curve type of the most enhancing tumor parts after NACT (calculated by CAD and manually). CONCLUSIONS: In the accurate evaluation of response to neoadjuvant treatment, CAD systems can provide useful additional information due to the high specificity; however, they cannot replace visual imaging evaluation. Besides traditional prognostic factors, contrast medium-induced dynamic MRI parameters reveal significant associations to patient outcome, i.e. occurrence of distant metastases.

Development of low-dose photon-counting contrast-enhanced tomosynthesis with spectral imaging.

PURPOSE: To demonstrate the feasibility of low-dose photon-counting tomosynthesis in combination with a contrast agent (contrast material-enhanced tomographic mammography) for the differentiation of breast cancer. MATERIALS AND METHODS: All studies were approved by the institutional review board, and all patients provided written informed consent. A phantom model with wells of iodinated contrast material (3 mg of iodine per milliliter) 1, 2, 5, 10, and 15 mm in diameter was assessed. Nine patients with malignant lesions and one with a high-risk lesion (atypical papilloma) were included (all women; mean age, 60.7 years). A multislit photon-counting tomosynthesis system was utilized (spectral imaging) to produce both low- and high-energy tomographic data (below and above the k edge of iodine, respectively) in a single scan, which allowed for dual-energy visualization of iodine. Images were obtained prior to contrast material administration and 120 and 480 seconds after contrast material administration. Four readers independently assessed the images along with conventional mammograms, ultrasonographic images, and magnetic resonance images. Glandular dose was estimated. RESULTS: Contrast agent was visible in the phantom model with simulated spherical tumor diameters as small as 5 mm. The average glandular dose was measured as 0.42 mGy per complete spectral imaging tomosynthesis scan of one breast. Because there were three time points (prior to contrast medium administration and 120 and 480 seconds after contrast medium administration), this resulted in a total dose of 1.26 mGy for the whole procedure in the breast with the abnormality. Seven of 10 cases were categorized as Breast Imaging Reporting and Data System score of 4 or higher by all four readers when reviewing spectral images in combination with mammograms. One lesion near the chest wall was not captured on the spectral image because of a positioning problem. CONCLUSION: The use of contrast-enhanced tomographic mammography has been demonstrated successfully in patients with promising diagnostic benefit. Further studies are necessary to fully assess diagnostic sensitivity and specificity.

Intra-individual comparison of average glandular dose of two digital mammography units using different anode/filter combinations.

RATIONALE AND OBJECTIVES: The aim of this study was to compare average glandular dose (AGD) in two full-field digital mammography units using different anode/filter combinations. MATERIALS AND METHODS: Mammographies of 50 consecutive patients on a mammography system using a tungsten/rhodium (W/Rh) anode/filter combination were retrospectively compared to prior examinations on a different mammography unit using combinations of Molybdenum (Mo) and Rhodium (Rh). To exclude effects of increasing patient age, two prior examinations within 5 years were used. Both views of one breast were chosen for analysis. AGD was recorded as stated by each mammography unit. Accuracy of stated AGD and contrast-detail resolution were assessed using different breast phantoms. RESULTS: The mean AGDs from the examinations using W/Rh were 0.95 mGy and 1.01 mGy for craniocaudal (CC) and mediolateral oblique (MLO) views compared to 1.51 mGy and 1.54 mGy, respectively, using combinations of Mo and Rh (P < .001). Relative reduction of AGD was independent of breast thickness but decreased with increasing breast density (partial correlation coefficient of 0.46, P < .005 and 0.57, P < .001, for CC and MLO views, respectively). Low-level contrast resolution was equal in both units using standard acquisition parameters. CONCLUSION: In clinical mammographies, higher energy beam spectra obtained using W/Rh anode/filter combinations may significantly contribute to lowering AGD compared to Mo/Mo, Mo/Rh, and Rh/Rh in breasts that are not extremely dense.

Determining optimal acquisition parameters for computed tomography coronary angiography: evaluation of a software-assisted, breathhold exam simulation.

RATIONALE AND OBJECTIVES: Scanning parameters used in multislice computed tomographic (MSCT) coronary angiography should be adapted to patients' heart rates. The aim of this study was to evaluate the rate of success of a software-assisted scan simulation to determine optimal gantry rotation time prior to MSCT coronary angiography. MATERIALS AND METHODS: Data from 218 64-slice MSCT coronary angiographic studies were retrospectively analyzed. Prior to the MSCT examination, a scan had been simulated by giving a breath-hold command, after which a software program recorded the patient's heart rate from an electrocardiogram over the expected scanning time and predicted optimal scanning parameters. The success rate in predicting optimal parameters for the subsequent MSCT examination and the resulting acquisition window width were analyzed. RESULTS: There was a wide range of heart rates among the patients. The mean intraindividual variation during scan simulation and examination was 4.8 beats/min. Optimal scan parameters were selected in 179 of 218 cases (82%). The median acquisition window width achieved in this group was 174 ms (range, 100-200), compared with 192 ms (range, 149-225) in cases in which suboptimal settings were selected (P < .001). Correct prediction occurred significantly more often in patients with low heart rates (<66 beats/min) than in those with higher heart rates (>or=66 beats/min) (93% vs 66%; P < .001). CONCLUSIONS: The software-assisted scan simulation was a fast and simple procedure that allowed the selection of optimal computed tomographic parameters in >80% of patients. The procedure may be a useful adjunct to avoid unwanted synchronicity of gantry rotation and heart cycle and optimize temporal resolution in MSCT coronary angiography.