Early Coronary Artery Calcification Progression over Two Years in Breast Cancer Patients Treated with Radiation Therapy: Association with Cardiac Exposure (BACCARAT Study).

Background: Radiotherapy (RT) for breast cancer (BC) can induce coronary artery disease many years after RT. At an earlier stage, during the first two years after RT, we aimed to evaluate the occurrence of increased coronary artery calcium (CAC) and its association with cardiac exposure. Methods: This prospective study included 101 BC patients treated with RT without chemotherapy. Based on CAC CT scans performed before and two years after RT, the event 'CAC progression' was defined by an increase in overall CAC score (CAC RT+ two years­CAC before RT > 0). Dosimetry was evaluated for whole heart, left ventricle (LV), and coronary arteries. Multivariable logistic regression models were used to assess association with doses. Results: Two years after RT, 28 patients presented the event 'CAC progression', explained in 93% of cases by a higher CAC score in the left anterior descending coronary (LAD). A dose−response relationship was observed with LV exposure (for Dmean LV: OR = 1.15, p = 0.04). LAD exposure marginally explained increased CAC in the LAD (for D2 LV: OR =1.03, p = 0.07). Conclusion: The risk of early CAC progression may be associated with LV exposure. This progression might primarily be a consequence of CAC increase in the LAD and its exposure.

Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study.

BACKGROUND: Radiotherapy (RT) for breast cancer presents a benefit in terms of reducing local recurrence and deaths resulting from breast cancer but it can lead to secondary effects due to the presence of neighboring cardiac normal tissues within the irradiation field. Breast RT has been shown to be associated with long-term increased risk of heart failure, coronary artery disease, myocardial infarction and finally cardiovascular death more than 10 years after RT. However, there is still a lack of knowledge for early cardiotoxicity induced by breast RT that can appear long before the onset of clinically significant cardiac events. Based on a 2-year follow-up prospective cohort of patients treated with breast RT, the BACCARAT (BreAst Cancer and CArdiotoxicity Induced by RAdioTherapy) study aims to enhance knowledge on detection and prediction of early subclinical cardiac dysfunction and lesions induced by breast RT and on biological mechanisms potentially involved, based on functional and anatomical cardiac imaging combined with simultaneous assessment of multiple circulating biomarkers and accurate heart dosimetry. METHODS/DESIGN: BACCARAT study consists in a monocentric prospective cohort study that will finally include 120 women treated with adjuvant 3D CRT for breast cancer, and followed for 2 years after RT. Women aged 50 to 70 years, treated for breast cancer and for whom adjuvant 3D CRT is indicated, without chemotherapy are eligible for the study. Baseline (before RT) and follow-up data include measurements of functional myocardial dysfunction including strain and strain rate based on 2D-speckle tracking echocardiography, anatomical coronary lesions including description of plaques in segments of coronary arteries based on Coronary computed tomography angiography, and a wide panel of circulating biomarkers. The absorbed dose is evaluated for the whole heart and its substructures, in particular the coronary arteries. Analysis on occurrence and evolution of subclinical cardiac lesions and biomarkers will be performed and completed with dose-response relationship. Multivariate model of normal tissue complication probability (NTCP) will also be proposed. DISCUSSION: Tools and results developed in the BACCARAT study should allow improving prediction and prevention of potential lesions to cardiac normal tissues surrounding tumors and ultimately enhance patients' care and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02605512.

Assessment of critical limb ischemia in patients with diabetes: comparison of MR angiography and digital subtraction angiography.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic accuracy of hybrid MR angiography by comparison with digital subtraction angiography (DSA) in diabetic patients with critical limb ischemia. SUBJECTS AND METHODS: Thirty-one patients prospectively underwent both hybrid MR angiography and DSA. The hybrid MR angiography study consisted of high-resolution MR angiography of a single calf and foot using a contrast-enhanced 3D gradient-echo volumetric interpolated breath-hold examination with surface coils, followed by three-station bolus chase MR angiography with a dedicated peripheral vascular coil. Two blinded reviewers separately analyzed maximum-intensity-projection hybrid MR angiograms and DSA images. The peripheral vessels were divided into 10 anatomic segments for review. The status of each segment was graded as normal, stenosis less than 50% in diameter, stenosis greater than 50%, or occluded. The sensitivity and specificity of hybrid MR angiography were determined using DSA as the gold standard. Treatment options were considered separately from the results of each examination. RESULTS: Among 310 analyzed segments, the sensitivities of hybrid MR angiography for stenosis and occlusion were, respectively, 95% and 95% for reviewer 1 and 96% and 90% for reviewer 2. The specificities of hybrid MR angiography for stenosis and occlusion were, respectively, 98% and 98% for reviewer 1 and 98% and 99% for reviewer 2. In 25 patients (81%), the quality of bolus chase MR angiography images was insufficient to assess runoff arteries. All treatments proposed on the basis of DSA findings were endorsed by hybrid MR angiography findings. Eleven more treatments were formulated on the basis of hybrid MR angiography findings. Of these, four were due to overestimation of stenosis on MR angiography and seven were due to the detection of patent infrageniculate arteries on hybrid MR angiography that were not detected on DSA. CONCLUSION: Hybrid MR angiography depicts runoff arteries not seen on DSA. Hybrid MR angiography may be useful for treatment planning in selected diabetic patients with critical limb ischemia.

Radiofrequency ablation of needle tract seeding in hepatocellular carcinoma.

A tumor needle tract seeding, 20 mm in diameter, was detected with magnetic resonance (MR) imaging in a 72-year-old man, 10 months after radiofrequency ablation of a 55-mm subcapsular hepatocellular carcinoma. This seeding was successfully treated with ultrasound-guided percutaneous radiofrequency ablation. No recurrence was found after a 2-year follow-up either on contrast-enhanced computed tomography or MR imaging. Needle tract seeding treatment is not well established. Percutaneous radiofrequency ablation of such seeding is one elegant potential treatment option. Efficacy seems promising but has to be confirmed in larger series. Further evaluation is needed.

Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results.

OBJECTIVE: The aims of this study were to develop a standardized one-step procedure for simultaneous high-resolution MRI of the axilla and bilateral breast MRI and to identify nodal features suggestive of metastatic involvement. SUBJECTS AND METHODS. We studied 16 women undergoing axillary lymph node dissection after combined bilateral breast MRI and high-resolution MRI of the axilla with a maximum in-plane resolution of 0.6 x 0.4 mm. MRI was performed using a standard double breast coil and a 15-cm round flexible surface coil adapted to the axilla. High-resolution axillary sequences, including inversion recovery T2- and spin-echo T1-weighted sequences, were performed before and after gadolinium chelates bolus injection. Axillary image analysis focused on nodal morphology including size, contour regularity, cortex and hilar appearance, signal intensity, and enhancement parameters. Axillary MRI findings were compared with the final pathogic results from axillary lymph node dissection in all patients. Patients were divided into groups according to the final pathologic axillary status. Differences in MRI lymph node features across the groups were tested using a t test for quantitative data and the chisquare test or Fisher's exact test for binary data. RESULTS: The features of the axilla on high-resolution MRI that best discriminated between patients with positive pathologic findings and those with negative pathologic findings were the presence of nodes with irregular contours (p < 10(-4)), high signal intensity on T2 sequences (p < 10(-3)), marked gadolinium enhancement (p < 10(-3)), and round hila and abnormal cortexes (p < 0.05). CONCLUSION: Breast tissue and axillary lymph nodes both can be analyzed on MRI in a one-step process using a bilateral breast coil combined with a surface coil. Morphologic features observed on high-resolution MRI of the axilla can improve the identification of metastatic nodes.

Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms.

STUDY DESIGN: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP). PATIENTS AND METHODS: Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases. With ultrasound-Doppler scan guidance, the PCFPs were percutaneously punctured with a 16-gauge intravenous catheter. An angiogram was performed through the catheter to ensure its location within the sac. Stainless steel spring coils with synthetic fibers were introduced within the PCFP with fluoroscopic control. Successful thrombosis was checked with ultrasound-Doppler scan and was repeated at days 1, 30, and 180 when possible. RESULTS: All PCFPs of 32-mm mean diameter were successfully treated with two to nine coils. After embolization, gentle additional compression was necessary for complete occlusion, with a mean duration of 6.3 minutes (range, 0 to 15 minutes), except in one case with treatment with abciximab in which it was 45 minutes. All procedures were uneventful and painless. The mean follow-up period was 9.5 months (range, 1 to 21 months). Two recurrences (11.7%) were observed, and one was successfully treated with a second embolization. CONCLUSION: Percutaneous embolization with coils appears to be a safe and effective method for treatment of PCFP. It may be performed in patients undergoing anticoagulant or antiplatelet therapy and must be attempted when ultrasound scan-guided compression repair has failed or is contraindicated.

Dilatation of the intrahepatic bile ducts associated with benign liver lesions: an unusual finding.

In three patients presenting different types of liver lesions, including isolated cyst, focal nodular hyperplasia (FNH), and hemangioma, intrahepatic bile duct dilatation was observed on US and CT. Final diagnosis was obtained by surgery in two cases (cyst and FNH) and by 1-year follow-up in one patient presenting an isolated hemangioma. The only common characteristic in our three cases was that lesions were present in segment four according to Couinaud's classification, at the level of the transverse fissure, suggesting that a space-occupying lesion at this site may cause compression of the common hepatic duct and right or left intrahepatic bile ducts. Our report indicates that compression may occur even with lesion of moderate size (35-40 mm in diameter). A benign liver lesion may cause a bile duct dilatation, particularly if located in segment 4, close to the hilum. Awareness of this possibility is important to avoid unnecessary invasive diagnostic procedures, particularly when all imaging criteria are consistent with a benign lesion.