Coronary artery disease prediction based on breast arterial calcification in women undergoing mammography as a screening for breast cancer.

OBJECTIVE: The aim of the study was to test the potential role of breast arterial calcification (BAC) in the prediction of coronary artery disease (CAD) in women. The criterion standard for CAD diagnostics was coronary angiography. METHODS: This retrospective study enrolled 163 consecutive women, who underwent digital mammography and coronary angiography in our hospital. We assessed the presence and severity of BAC, and tested whether the presence and/or extent of BAC could be a predictor for CAD, quantified by Gensini score. RESULTS: BAC was presented in 34 patients (21%). Neither the presence of CAD (17 patients, 50%, vs 55 42.6%, P = 0.44), nor the Gensini score (20.5 ±â€Š29.7 vs 15.4 ±â€Š24.1, P = 0.3) differed significantly between BAC-present and BAC-absent patients.A finding of triple-vessel disease, however, more frequently occurred in the BAC-present (seven patients, 20.6%) than in the BAC-absent (nine patients, 7%) group, odds ratio (OR) 3.1, 95% CI 1-9.5, P = 0.049. The presence of BAC did not significantly increase the odds for the presence of CAD (OR = 1.29, P = 0.54). Among the subgroup of patients with CAD, BAC presence was associated with triple vessel disease (OR = 3.34, P = 0.049). CONCLUSIONS: We did not confirm BAC as a predictor of CAD. However, BAC showed association with more severe forms of coronary atherosclerosis (triple vessel disease).

Video Summary:http://links.lww.com/MENO/A728 .

Evaluation of the personalized invitation of Czech citizens to screening programs.

The Czech population has high burden of malignant tumors, and screening programs are therefore an essential part of cancer control policy. At the beginning of 2014 personalized invitation of Czech citizens for cancer screening programs was launched to promote higher coverage by screening. The aim of the paper is to present the up-to-date results of the personalized invitation. The data from health insurance companies were used to evaluate the volume of invitations for cancer screening programs and the participation rate after invitation in 2014-2017. During the first four years of the project, over 6 million invitations were sent (approximately 3 million individuals were invited). Participation rates after the first invitation in the breast, colorectal and cervical screening were 22.3%, 21.7% and 15.5%. However, the effect of personalized invitations decreases with repeated invitations to participate. Personalized invitation contributed to screening in hundreds of thousands citizens, but a large proportion of invited people still do not participate. It is necessary to encourage personalized invitation and discuss other strategies to motivate the public to participate in screening programs.

A computer-assisted system for handheld whole-breast ultrasonography.

PURPOSE: Breast ultrasonography (US) presents an alternative to mammography in young asymptomatic individuals and a complementary examination in screening of women with dense breasts. Handheld US is the standard-of-care, yet when used in whole-breast examination, no effort has been devoted to monitoring breast coverage and missed regions, which is the purpose of this study. METHODS: We introduce a computer-aided system assisting radiologists and US technologists in covering the whole breast with minimum alteration to the standard workflow. The proposed system comprises a standard US device, proprietary electromagnetic 3D tracking technology and software that combines US visual and tracking data to estimate a probe trajectory, total time spent in different breast segments, and a map of missed regions. A case study, which involved four radiologists (two junior and two senior) performing whole-breast ultrasound in 75 asymptomatic patients, was conducted to test the importance and relevance of the system. RESULTS: The mean process time per breast was [Formula: see text], with no statistically significant difference between the left and the right sides, and slightly longer examination time of junior radiologists. The process time density shows that central parts of the breast have better coverage compared to the periphery. Within the central part, missed regions of minimum detectable size of [Formula: see text] occur in [Formula: see text] of examinations, and non-negligible [Formula: see text] regions occur in [Formula: see text] of cases. CONCLUSION: The results of the case study indicate that missed regions are present in handheld whole-breast US, which renders the proposed system for tracking the probe position during examination a valuable tool for monitoring coverage.

Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need.

BACKGROUND: Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent. AIM: To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years. METHODS: We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations. RESULTS: The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = -0.88, p = 0.0001), the proportion of important findings on cranial CT (r = -0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = -0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062). CONCLUSIONS: The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.

Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.

EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. KEY POINTS: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future.

Computed Tomography Colonography Phantom: Construction, Validation and Literature Review.

BACKGROUND: Several dedicated computed tomography (CT) colonography phantoms have been described previously. OBJECTIVES: To compare their pros and cons and describe the construction of a dedicated phantom that can be easily manufactured. MATERIALS AND METHODS: We found 15 different phantom designs by literature search and compared their advantages and disadvantages based on their description and images. We tested various materials for density and mechanical properties and constructed a phantom from polypropylene pipes (30 mm and 50 mm in diameter, 52 cm in length). Haustral folds were created by heat shaping and 39 intermediate sessile polyps with a target size of 6-10 mm and two flat lesions were created from silicone. Nine polyps were attached to a fold. The model was placed in a 30-cm barrel filled with water to simulate attenuation of human body. Attenuation of polyps was compared to intermediate polyps found in patients. RESULTS: None of the earlier colonic phantoms found in the literature incorporated all the properties that would ensure both reproducibility and validity of the model (including a rigid wall, density of the wall and polyps similar to human colon, at least two levels of distension and durability). In the present phantom, the average size of sessile polyps was 8.6 ± 0.9 mm and their density was 53 ± 24 HU. We found no significant difference in polyp density between simulated polyps in the phantom and polyps in human subjects (P = 0.70). All polyps, with the exception of one flat lesion, were detected by computer aided detection. CONCLUSION: We constructed and validated a CT colonography phantom with correct density allowing performance of reproducible experiments.

Sub-milliSievert ultralow-dose CT colonography with iterative model reconstruction technique.

Purpose. The purpose of this study was to evaluate the technical and diagnostic performance of sub-milliSievert ultralow-dose (ULD) CT colonograpy (CTC) in the detection of colonic and extracolonic lesions. Materials and Methods. CTC with standard dose (SD) and ULD acquisitions of 64 matched patients, half of them with colonic findings, were reconstructed with filtered back projection (FBP), hybrid (HIR) and iterative model reconstruction techniques (IMR). Image noise in six colonic segments, in the left psoas muscle and aorta were measured. Image quality of the left adrenal gland and of the colon in the endoscopic and 2D view was rated on a five point Likert scale by two observers, who also completed the reading of CTC for colonic and extracolonic findings. Results. The mean radiation dose estimate was 4.1 ± 1.4 mSv for SD and 0.86 ± 0.17 mSv for ULD for both positions (p < 0.0001). In ULD-IMR, SD-IMR and SD-HIR, the endoluminal noise was decreased in all colonic segments compared to SD-FBP (p < 0.001). There were 27 small (6-9 mm) and 17 large (≥10 mm) colonic lesions that were classified as sessile polyps (n = 38), flat lesions (n = 3), or as a mass (n = 3). Per patient sensitivity and specificity were 0.82 and 0.93 for ULD-FBP, 0.97 and 0.97 for ULD-HIR, 0.97 and 1.0 for ULD-IMR. Per polyp sensitivity was 0.84 for ULD-FBP, 0.98 for ULD-HIR, 0.98 for ULD-IMR. Significantly less extracolonic findings were detected in ULD-FBP and ULD-HIR, but in the E4 category by C-RADS (potentially important findings), the detection was similar. Conclusion. Both HIR and IMR are suitable for sub-milliSievert ULD CTC without sacrificing diagnostic performance of the study.

Ultrasound-guided cryoablation of breast fibroadenoma: a pilot trial.

PURPOSE: The aim of the study was to evaluate cryoablation (CA) under ultrasound guidance in the office setting with liquid nitrogen system for patients with fibroadenoma (FA). METHODS: For this prospective multicenter trial, an office-based cryosurgical system was used to treat histological confirmed benign FA with a maximum dimension of 3 cm. Sixty CA procedures were performed under ultrasound guidance. A freeze-thaw-freeze treatment cycle was performed according to the size of the FA. During the CA procedure continuous ultrasound monitoring was performed, verifying engulfment of the FA. Patients attended four follow-up visits at 1 week, 3, 6 months and 1 year and underwent ultrasound, physical examination and photography. RESULTS: Data were collected and analyzed in 60 cases. 59 of 60 FA (98 %) were fully engulfed by the ice ball. No serious adverse events occurred related to the IceSense3 system. At the 1-year follow-up, the FAs were gone in 93% of the cases. Prior to CA procedure, 76% of the FAs were palpable. Afterwards in some cases (22%), a scar/cryo lesion was palpable. 28% of the patients reported pain, described as mild or moderate, compared to 2% after 1 year. Cosmetic results at 12 months follow-up were reported as good or excellent in 100% by physician and in 97% by patients. CONCLUSIONS: The cryodestruction of the FA using liquid nitrogen system proved functional and safe, while showing meaningful reduction in volume, palpability, pain and cosmetic satisfying outcomes.

Submilisievert ultralow-dose CT colonography using iterative reconstruction technique: a feasibility study.

BACKGROUND: Computed tomography (CT) colonography is a well established modality for the examination of symptomatic patients as well as in screening. Recent technical advances in improving image quality by iterative reconstruction contribute to the reduction of the radiation dose which is a major concern in CT imaging. PURPOSE: To evaluate image quality of ultralow-dose submilisievert CT colonography using hybrid iterative reconstruction technique. MATERIAL AND METHODS: Sixteen patients underwent contrast-enhanced CT colonography with standard protocol in supine position and ultralow-dose protocol in prone position. Ultralow-dose datasets were reconstructed with filtered back projection and an advanced hybrid iterative reconstruction technique. Two radiologists independently evaluated 96 colonic segments for image quality in the endoluminal view and axial thin sections. Colonic distension, smoothness of colonic wall and distortion of folds in the endoluminal view, sharpness of colonic wall delineation, perceived image noise, and presence of photon starvation artifact were rated on a five-point scale. Intraluminal noise expressed as standard deviation of Hounsfield density was measured in all segments. RESULTS: The mean radiation dose was 0.42 mSv and 5.48 mSv in prone and supine scans, respectively. All distended segments were rated evaluable in standard dose and ultralow-dose series reconstructed with the iterative reconstruction technique, whereas in 61% segments image quality was rated poor or unacceptable in ultralow-dose series where filtered back projection was used with worst ratings in the rectum and the sigmoid colon. CONCLUSION: This pilot study shows that iterative reconstruction technique is a feasible method to decrease the radiation dose from CT colonography for both positions below 1mSv. Further investigations of larger scale need to be done to clarify, whether such a low radiation dose would influence the detection of polyps.

Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme.

BACKGROUND: The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme. METHODS: The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring. RESULTS: Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines. CONCLUSIONS: Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.

Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI.

AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrast-enhanced US (n = 134), contrast-enhanced CT (n = 115) and/or dynamic contrast-enhanced MRI (n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology (n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. RESULTS: In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue-enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. CONCLUSION: SonoVue-enhanced sonography emerges as the most sensitive, most specific and thus most accurate imaging modality for the characterization of focal liver lesions.

Computer-aided evaluation of screening mammograms based on local texture models.

We propose a new approach to diagnostic evaluation of screening mammograms based on local statistical texture models. The local evaluation tool has the form of a multivariate probability density of gray levels in a suitably chosen search window. First, the density function in the form of Gaussian mixture is estimated from data obtained by scanning of the mammogram with the search window. Then we evaluate the estimated mixture at each position and display the corresponding log-likelihood value as a gray level at the window center. The resulting log-likelihood image closely correlates with the structural details of the original mammogram and emphasizes unusual places. We assume that, in parallel use, the log-likelihood image may provide additional information to facilitate the identification of malignant lesions as atypical locations of high novelty.

Secondary-progressive form of multiple sclerosis: MRI changes versus clinical status.

OBJECTIVES: To monitor the interaction between the clinical manifestation of the secondary progressive form of multiple sclerosis (SPMS) expressed in the Expanded Disability Status Scale (EDSS) and abnormal findings in magnetic resonance imaging (MRI) of the brain. To compare a time line of brain atrophy in patients with SPMS, patients with relapsing-remitting multiple sclerosis (RRMS) and the healthy population. METHODS: Brain atrophy, volume of increased signal lesions on Fluid Attenuated Inversion Recovery Sequence (FLAIR) sequence (s.c.lesion load) and decreased signal lesions on T1 weighted sequence (s.c. black holes) were measured semi-automatically and correlated with EDSS in 12 patients. Further, we compared a time line of brain parenchyma fraction (BPF) loss in patients with SPMS, patients with RRMS and the healthy population. RESULTS: In patients with SPMS, no statistical correlation was found between lesion load in FLAIR and EDSS and there was also no significant statistical correlation (p=0.1134) between the volume of "black holes" and EDSS. However, we did confirm a significant correlation between increase in brain atrophy and clinical status (p=0.0093). Comparison of patients with SPMS or RRMS and the healthy population revealed that brain atrophy progressed most rapidly in patients with SPMS. CONCLUSIONS: The presence of a statistically significant difference in BPF loss between patients with SPMS or RRMS and the healthy population merits further study despite the small size of our sample. We postulate that the measurement of brain atrophy could be helpful in determining the transition of RRMS to SPMS and thereby predict the progression of the disease in the future.

Breast cancer risk assessment in the Czech female population--an adjustment of the original Gail model.

BACKGROUND: Several mathematical models have been developed for predicting individual breast cancer risk. Such models can help clinicians to choose appropriate preventive and therapeutic interventions for each patient. Unfortunately, the validity of these models has not been tested outside the USA. METHODS: The authors describe a case-control study in the Czech Republic with a similar design to that of the US Breast Cancer Detection and Demonstration Project (BCDDP). The main objective of the study was to evaluate the validity of the Gail model in the Czech female population, and to develop a local model using the same statistical approach as the Gail model. Between November 2000 and May 2004, 14,566 questionnaires containing case history data from both healthy women (control group) and women with breast cancer were collected. Case-control age-matched pairs (n = 4598) have subsequently been matched and analyzed. RESULTS: Our results show that the original Gail model was not able to properly distinguish between controls and breast cancer cases in the Czech female population. Based on paired data, the mean 5-year and life-time breast cancer risk was 1.379 +/- 0.668 and 7.990 +/- 3.184 in the control group and 1.375 +/- 0.692 and 8.028 +/- 3.506 in the patients with breast cancer group. The original Gail model was also not able to properly describe age-specific baseline risk of breast cancer development in the Czech population. In response the authors developed two variants of modified/locally adjusted models. CONCLUSION: The original Gail model is not an accurate breast cancer risk assessment tool for the Czech female population.

Assessment of in vitro drug resistance of human breast cancer cells subcultured from biopsy specimens.

UNLABELLED: The low cellular yield of a breast cancer sample represents a limiting factor for in vitro chemosensitivity/chemoresistance testing. The use of in vitro serially cultured cells can help overcome this obstacle. MATERIALS AND METHODS: In vitro drug resistance of cells cultured from mammary carcinomas by the 3T3 feeder-layer technique was tested by the MTT assay. Out of the 33 tested cultures, 9 were derived from cells obtained from true-cut biopsies of primary tumours, with sample volume less than 0.03 cm3. The cultures were treated with 6 anticancer drugs at 6-8 concentrations. The chemoresistance of cultured cells was monitored by the surviving cell fraction as a function of the drug concentration. RESULTS: The average time to obtain a result was 28 days. The volume of an original sample had no effect on the in vitro resistance of a culture, suggesting minimal alteration of in vitro chemosensitivity of cells by their cultivation. Histopathological grade, estrogen receptor status or expression of the c-erb-B2 protein of the original tumours did not significantly correlate with the resistance of cultures. Individual drugs displayed distinct in vitro effectiveness. Paclitaxel and cisplatin were the most potent drugs. Gemcitabine, vinorelbine and mafosfamide were the least potent drugs. Doxorubicin and gemcitabine most frequently failed to completely metabolically inhibit 100% of cultured cells at any concentration. CONCLUSION: Combination of the optimised feeder-layer cultivation technique and the MTT test permits extensive drug resistance testing from very small breast cancer samples.

Endovascular treatment of central vein stenoses and/or occlusions in hemodialysis patients.

PURPOSE: To report our experience and results with the endovascular treatment of central vein stenoses and occlusions in hemodialysis patients. METHODS: Between October 1999 and August 2001 (22 months) we performed 22 interventional procedures in 14 hemodialysis patients (8 women, 6 men) ranging in age from 38 to 87 years (mean 76 years). The indication for intervention was stenosis (n = 10) or occlusion (n = 4) of a central vein in the upper arm used for dialysis in patients with arm swelling and/or shunt malfunction. All patients had a previous history of subclavian vein cannulation. There were six percutaneous transluminal angioplasties (PTAs) and eight primary stent placements and eight repeat interventions. Seven were for restenoses and one for early occlusion, with two secondary stent placements and six PTA of in-stent stenoses. In two patients a second stent was implanted. The mean follow-up was 8.5 months (range 1-19 months). All stents were self-expandable with diameters ranging from 9 to 16 mm. RESULTS: All but one of the procedures was technically successful (95%, n = 21). The patient with an unsuccessful procedure died 1 month after the procedure, but the death was not procedure-related. During follow-up three patients died with a patent shunt and central vein, none of them in connection with the procedure. No complication occurred during the interventional procedures. One patient was lost to follow-up. The primary patency rate at 12 months was 43%, with a primary assisted patency rate of 83% and a secondary patency rate of 100% (n = 6). CONCLUSION: Central vein stenoses and occlusions are associated with previous subclavian vein cannulation. They are a serious problem in hemodialysis patients with a shunt on the same arm. Endovascular treatment is a suitable option for these patients.