ABSTRACT
AIMS: We prospectively compared the ability of magnetic resonance imaging (MRI) to measure residual breast cancer in patients treated with different neoadjuvant chemotherapy regimen. METHODS: Forty patients with locally advanced breast carcinoma underwent neoadjuvant chemotherapy. Twelve patients received 5-fluoro-uracyl-epirubicin-cyclophosphamide (FEC-group, six cycles), 28 (DXL-group) received docetaxel-based chemotherapy (six cycles DXL-epirubicin: 13 patients, eight cycles DXL alone: 15 patients). All patients had baseline and preoperative MRI. The spread of pathologic residual disease (PRd) was compared to preoperative MRI measures according to chemotherapy regimen. RESULTS: MRI over/underestimation of the spread of residual tumour was never superior to 15mm in FEC group, whereas it appeared in 11/28 (39%, 30-48%-95% CI) patients in DXL group (p=0.017). Tumour shrinkage led to single nodular residual lesions in FEC group, whereas vast numerous microscopic nests were observed in docetaxel group in pathology. CONCLUSION: Among tumours treated with a taxane-containing regimen, residual disease was frequently underestimated by MRI because of PRd features.
Subject(s)
Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Contrast Media , Magnetic Resonance Imaging , Neoadjuvant Therapy , Taxoids/administration & dosage , Adult , Antibiotics, Antineoplastic/administration & dosage , Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Agents, Alkylating/administration & dosage , Breast Neoplasms/pathology , Carcinoma/drug therapy , Carcinoma/pathology , Cyclophosphamide/administration & dosage , Docetaxel , Epirubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Mastectomy , Mastectomy, Segmental , Middle Aged , Neoplasm, Residual , Prospective StudiesABSTRACT
The purpose of this paper is to report the clinical, imaging (sonographic, mammographic and MRI) and pathological features of breast angiosarcoma, a rare but aggressive tumor, based on a review of two cases.
Subject(s)
Breast Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Magnetic Resonance Imaging , Mammography , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnostic imaging , Female , Hemangiosarcoma/diagnostic imaging , Humans , UltrasonographyABSTRACT
PURPOSE: to estimate from phantom measurements the radiation dose and the accuracy of helical ct pelvimetry. MATERIALS AND METHODS: Eight helical CT acquisitions using different tube current (100, 50, 25 or 10mAs) and pitch factor (1.125 or 1.375) settings but identical collimation (2mm) and kilovoltage (120 kVp) were evaluated using a four-channel MDCT scanner and compared with conventional CT pelvimetry including a single scout and two transverse images. A plexiglas phantom combined with an ionization chamber was used to calculate the CTDIw and DLP for each acquisition. Then, an ex vivo phantom of bony pelvis was used to evaluate the accuracy of helical acquisitions for the measurement of pelvic diameters (i.e. the antero-posterior inlet, the transverse inlet and the interspinous distance). Reconstructions of helical acquisitions were performed using 2D MPR, 3D MIP and 3D SSD algorithms. RESULTS: CTDIw and DLP of conventional pelvimetry were 26 mGy and 42 mGy.cm respectively. The radiation dose of helical acquisitions decreased linearly with tube current (CTDIw: from 13 to 1.3 mGy, DLP: from 218.3 to 18.7 mGy.cm). Compared to conventional CT, the dose was nearly similar at 25 mAs and reduced at 10 mAs. Helical acquisitions provided accurate measurements of pelvic diameters with a pitch of 1.125 and a 2D MPR algorithm to evaluate the AP inlet and a 3D MIP algorithm to evaluate the transverse inlet and the interspinous distance. Variations of tube current did not influence the accuracy of pelvic diameter measurement. CONCLUSION: Our results suggest that accurate low-dose helical CT pelvimetry using 10-25 mAs and a pitch factor of 1.125 combined with 2D MPR and 3D MIP reconstructions is possible.
Subject(s)
Image Processing, Computer-Assisted , Pelvimetry , Radiation Dosage , Tomography, Spiral Computed , Algorithms , Anthropometry , Clinical Protocols/standards , Feasibility Studies , Humans , Image Processing, Computer-Assisted/instrumentation , Image Processing, Computer-Assisted/methods , Image Processing, Computer-Assisted/standards , Pelvic Bones/diagnostic imaging , Pelvimetry/adverse effects , Pelvimetry/instrumentation , Pelvimetry/methods , Pelvimetry/standards , Phantoms, Imaging , Radiometry , Tomography, Spiral Computed/adverse effects , Tomography, Spiral Computed/instrumentation , Tomography, Spiral Computed/methods , Tomography, Spiral Computed/standardsABSTRACT
The natural history of bronchogenic carcinoma shows that 42% of patients are diagnosed with cancer-related neurological complications either at initial presentation or at follow-up that can be separated in 3 different categories: - locoregional involvement of cervicothoracic nerves (recurrent laryngeal nerves, phrenic and vagus nerves, brachial plexus and sympathetic cervical chains), - metastatic disease characterized by intracranial lesions (brain, meningeal, ependymal and pituitary metastases) and spinal (extradural, subarachnoid and medullary metastases) lesions, - paraneoplastic syndromes including limbic encephalitis, Lambert-Eaton syndrome and paraneoplastic cerebellar degeneration. These neurological disorders usually are associated with advanced cancer for which radical surgical management seldom is indicated. All imaging studies performed at the time of initial staging for bronchogenic carcinoma should therefore be carefully reviewed in order to detect signs that could suggest the presence of one or several neurological complications. The goals of this paper are to describe the clinical signs and to illustrate the imaging features of neurological complications related to bronchogenic carcinoma at conventional radiography, CT and MRI.