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1.
Radiology ; 301(2): 295-308, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34427465

RESUMEN

Background Suppression of background parenchymal enhancement (BPE) is commonly observed after neoadjuvant chemotherapy (NAC) at contrast-enhanced breast MRI. It was hypothesized that nonsuppressed BPE may be associated with inferior response to NAC. Purpose To investigate the relationship between lack of BPE suppression and pathologic response. Materials and Methods A retrospective review was performed for women with menopausal status data who were treated for breast cancer by one of 10 drug arms (standard NAC with or without experimental agents) between May 2010 and November 2016 in the Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and Molecular Analysis 2, or I-SPY 2 TRIAL (NCT01042379). Patients underwent MRI at four points: before treatment (T0), early treatment (T1), interregimen (T2), and before surgery (T3). BPE was quantitatively measured by using automated fibroglandular tissue segmentation. To test the hypothesis effectively, a subset of examinations with BPE with high-quality segmentation was selected. BPE change from T0 was defined as suppressed or nonsuppressed for each point. The Fisher exact test and the Z tests of proportions with Yates continuity correction were used to examine the relationship between BPE suppression and pathologic complete response (pCR) in hormone receptor (HR)-positive and HR-negative cohorts. Results A total of 3528 MRI scans from 882 patients (mean age, 48 years ± 10 [standard deviation]) were reviewed and the subset of patients with high-quality BPE segmentation was determined (T1, 433 patients; T2, 396 patients; T3, 380 patients). In the HR-positive cohort, an association between lack of BPE suppression and lower pCR rate was detected at T2 (nonsuppressed vs suppressed, 11.8% [six of 51] vs 28.9% [50 of 173]; difference, 17.1% [95% CI: 4.7, 29.5]; P = .02) and T3 (nonsuppressed vs suppressed, 5.3% [two of 38] vs 27.4% [48 of 175]; difference, 22.2% [95% CI: 10.9, 33.5]; P = .003). In the HR-negative cohort, patients with nonsuppressed BPE had lower estimated pCR rate at all points, but the P values for the association were all greater than .05. Conclusions In hormone receptor-positive breast cancer, lack of background parenchymal enhancement suppression may indicate inferior treatment response. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante/métodos , Medios de Contraste , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Terapia Neoadyuvante/métodos , Adulto , Anciano , Mama/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
2.
NPJ Breast Cancer ; 6(1): 63, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33298938

RESUMEN

Dynamic contrast-enhanced (DCE) MRI provides both morphological and functional information regarding breast tumor response to neoadjuvant chemotherapy (NAC). The purpose of this retrospective study is to test if prediction models combining multiple MRI features outperform models with single features. Four features were quantitatively calculated in each MRI exam: functional tumor volume, longest diameter, sphericity, and contralateral background parenchymal enhancement. Logistic regression analysis was used to study the relationship between MRI variables and pathologic complete response (pCR). Predictive performance was estimated using the area under the receiver operating characteristic curve (AUC). The full cohort was stratified by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status (positive or negative). A total of 384 patients (median age: 49 y/o) were included. Results showed analysis with combined features achieved higher AUCs than analysis with any feature alone. AUCs estimated for the combined versus highest AUCs among single features were 0.81 (95% confidence interval [CI]: 0.76, 0.86) versus 0.79 (95% CI: 0.73, 0.85) in the full cohort, 0.83 (95% CI: 0.77, 0.92) versus 0.73 (95% CI: 0.61, 0.84) in HR-positive/HER2-negative, 0.88 (95% CI: 0.79, 0.97) versus 0.78 (95% CI: 0.63, 0.89) in HR-positive/HER2-positive, 0.83 (95% CI not available) versus 0.75 (95% CI: 0.46, 0.81) in HR-negative/HER2-positive, and 0.82 (95% CI: 0.74, 0.91) versus 0.75 (95% CI: 0.64, 0.83) in triple negatives. Multi-feature MRI analysis improved pCR prediction over analysis of any individual feature that we examined. Additionally, the improvements in prediction were more notable when analysis was conducted according to cancer subtype.

3.
Radiology ; 246(3): 742-53, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18195386

RESUMEN

PURPOSE: To retrospectively compare image quality, radiation dose, and blood vessel assessability for coronary artery computed tomographic (CT) angiograms obtained with a prospectively gated transverse (PGT) CT technique and a retrospectively gated helical (RGH) CT technique. MATERIALS AND METHODS: This HIPAA-compliant study received a waiver for approval from the institutional review board, including one for informed consent. Coronary CT angiograms obtained with 64-detector row CT were retrospectively evaluated in 203 clinical patients. A routine RGH technique was evaluated in 82 consecutive patients (44 males, 38 females; mean age, 55.6 years). The PGT technique was then evaluated in 121 additional patients (71 males, 50 females; mean age, 56.7 years). All images were evaluated for image quality, estimated radiation dose, and coronary artery segment assessability. Differences in image quality score were evaluated by using a proportional odds logistic regression model, with main effects for three readers, two techniques, and four arteries. RESULTS: The mean effective dose for the group with the PGT technique was 2.8 mSv; this represents an 83% reduction as compared with that for the group with the RGH technique (mean, 18.4 mSv; P < .001). The image quality score for each of the arteries, as well as the overall combined score, was significantly greater for images obtained with PGT technique than for images obtained with RGH technique. The combined mean image quality score was 4.791 for images obtained with PGT technique versus 4.514 for images obtained with RGH technique (proportional odds model odds ratio, 2.8; 95% confidence interval: 1.7, 4.8). The percentage of assessable coronary artery segments was 98.6% (1196 of 1213) for images obtained with PGT technique versus 97.9% (1741 of 1778) for images obtained with RGH technique (P = .83). CONCLUSION: PGT coronary CT angiography offers improved image quality and substantially reduced effective radiation dose compared with traditional RGH coronary CT angiography.


Asunto(s)
Angiografía Coronaria/métodos , Enfermedad Coronaria/diagnóstico por imagen , Tomografía Computarizada Espiral/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Medios de Contraste , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Dosis de Radiación , Estudios Retrospectivos , Ácidos Triyodobenzoicos
4.
Radiology ; 222(2): 305-12, 2002 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11818592

RESUMEN

The radiographic and computed tomographic (CT) findings in two patients with documented inhalational anthrax resulting from bioterrorism exposure are presented. Chest radiographs demonstrated mediastinal widening, adenopathy, pleural effusions, and air-space disease. Chest CT images revealed enlarged hyperattenuating mediastinal and hilar lymph nodes and edema of mediastinal fat. Chest CT findings are helpful for making the initial diagnosis. To the authors' knowledge, the spectrum and follow-up of CT findings have not been previously described.


Asunto(s)
Carbunco/diagnóstico por imagen , Bioterrorismo , Enfermedades Profesionales/diagnóstico por imagen , Servicios Postales , Infecciones del Sistema Respiratorio/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Humanos , Masculino , Persona de Mediana Edad , Sobrevivientes
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