RESUMO
OBJECTIVE: To evaluate the diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM) in comparison with that of full-field digital mammography (FFDM), either alone or accompanied with breast ultrasound (BUS) in a large series of patients/breast lesions (n = 644). PATIENTS AND METHODS: In this retrospective study, five radiologists evaluated the lesions by three imaging modalities: FFDM, FFDM + BUS, and CESM and compared the imaging to the gold standard (histopathology or clinical follow-up). Diagnostic performance parameters and receiver operating characteristic (ROC) curves of CESM were calculated and compared to those of FFDM or FFDM + BUS (McNemar's test). Additionally, the reliability of tumor size measurement by CESM was compared with the histopathological measurement. RESULTS: The study included 218 benign and 426 malignant lesions. 85% of benign and 93% of malignant lesions were adequately identified using CESM. With respect to FFDM and FFDM + BUS, CESM significantly increased sensitivity to 93.2% (+ 10.7% and + 3.4%, respectively); specificity to 84.4% (+ 15.8% and + 1.7%, respectively); PPV to 92.3% (+ 26.8% and + 3.6%, respectively); NPV to 86.0% (+ 1.6% and + 1.8%, respectively); and accuracy to 90.2% (+ 15.8% and + 3.2%, respectively). In the ROC curves analyses, the comparison among the three AUC values was also statistically significant (p < 0.001). Good agreement between tumor diameters measured using CESM and histopathology was observed (Spearman's rank correlation, r = 0.891, p < 0.0001), although this technique tended to produce an overestimation of the size (+ 7 mm). CONCLUSIONS: CESM has high diagnostic accuracy and can be considered as a useful technique for the assessment of breast lesions.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Iohexol/análogos & derivados , Mamografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Iohexol/administração & dosagem , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia MamáriaRESUMO
Se presenta la experiencia con 72 pacientes con diferentes patologías, en quienes se realizó tratamiento endovascular con embolización selectiva. Se discuten la técnica, diferentes materiales utilizados, resultados y complicaciones. Se concluye que la EE constituye una excelente alternativa terapéutica pre-quirúrgica, paliativa o definitiva, de fácil realización en centros especialmente entrenados
Assuntos
Humanos , Masculino , Feminino , Embolização Terapêutica/métodos , Aneurisma/terapia , Angiografia , Meios de Contraste , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Epistaxe/terapia , Esponja de Gelatina Absorvível/uso terapêutico , Hematúria/terapia , Hemoptise/terapia , Iodatos , Neoplasias Renais/terapia , Metilcelulose/uso terapêutico , Cuidados Paliativos , Varicocele/terapiaRESUMO
Se presenta la experiencia con 72 pacientes con diferentes patologías, en quienes se realizó tratamiento endovascular con embolización selectiva. Se discuten la técnica, diferentes materiales utilizados, resultados y complicaciones. Se concluye que la EE constituye una excelente alternativa terapéutica pre-quirúrgica, paliativa o definitiva, de fácil realización en centros especialmente entrenados