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1.
Radiology ; 295(3): 517-526, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32228293

RESUMO

Background Higher peak enhancement and washout component values measured on preoperative breast MRI scans with computer-aided diagnosis (CAD) are presumed to be associated with worse recurrence-free survival. Purpose To investigate whether CAD-extracted kinetic features of breast cancer and the heterogeneity of these features at preoperative MRI are associated with distant metastasis-free survival in women with invasive breast cancer. Materials and Methods Consecutive women with newly diagnosed invasive breast cancer who underwent preoperative MRI were retrospectively evaluated between 2011 and 2012. A commercially available CAD system was used to extract the peak enhancement and delayed enhancement profiles of each breast cancer case from preoperative MRI data. The kinetic heterogeneity of these features (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was calculated to evaluate intratumoral heterogeneity. Cox proportional hazards models were used to investigate the associations between CAD-extracted kinetic features and distant metastasis-free survival after adjusting for clinical-pathologic factors. Results A total of 276 consecutive women (mean age, 53 years) were evaluated. In 28 of 276 (10.1%) women, distant metastasis developed at a median follow-up of 79 months. A higher degree of kinetic heterogeneity was observed in women with distant metastases than in those without distant metastases (mean, 0.70 ± 0.2 vs 0.43 ± 0.3; P < .001). Multivariable Cox proportional hazards analysis revealed that a higher degree of kinetic heterogeneity (hazard ratio [HR], 19.2; 95% confidence interval [CI]: 4.2, 87.1; P < .001), higher peak enhancement (HR, 1.001; 95% CI: 1.000, 1.002; P = .045), the presence of lymphovascular invasion (HR, 3.3; 95% CI: 1.5, 7.5; P = .004), and a higher histologic grade (ie, grade 3) (HR, 2.2; 95% CI: 1.0, 4.9; P = .044) were associated with worse distant metastasis-free survival. Conclusion Higher values of kinetic heterogeneity and peak enhancement as determined with computer-aided diagnosis of preoperative MRI were associated with worse distant metastasis-free survival in women with invasive breast cancer. © RSNA, 2020 See also the editorial by El Khouli and Jacobs in this issue.

2.
J Cardiovasc Imaging ; 28(1): 21-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31805621

RESUMO

BACKGROUND: To assess left ventricular function and coronary artery simultaneously by third-generation dual-source computed tomography (CT) using a low radiation dose. METHODS: A total of 48 patients (36 men, 12 women; mean age 57.0 ± 9.5 years) who underwent both electrocardiography-gated cardiac CT angiography (CCTA) using 70-90 kVp and echocardiography were included in this retrospective study. The correlation between left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) measured using CCTA and echocardiography was determined. The quality of coronary artery images was analyzed using a 4-point scale (1, excellent; 4, poor). The effective radiation dose of CCTA was calculated. RESULTS: Mean heart rate during the CT examination was 59.9 ± 9.9 bpm (range 38-79) and the body mass index of 48 patients was 24.5 ± 2.6 kg/m² (range 17.0-29.4). LVEDV, LVESV, and LVEF measured using CCTA and echocardiography demonstrated a fair to moderate correlation (Pearson correlation coefficient: r = 0.395, p = 0.005 for LVEDV; r = 0.509. p < 0.001 for LVESV; r = 0.551, p < 0.001 for LVEF). Average image quality score of coronary arteries was 1.0 ± 0.1 (range 1-2). A total of 99.0% (783 of 791) of segments had an excellent image quality score, and 1.0% (8 of 791) of segments had a good score. Mean effective radiation dose was 2.2 ± 0.7 mSv. CONCLUSIONS: Third-generation dual-source CT using a low tube voltage simultaneously provides information regarding LV function and coronary artery disease at a low radiation dose. It can serve as an alternative option for functional assessment, particularly when other imaging modalities are inadequate.

3.
Jpn J Radiol ; 38(2): 101-111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31848888

RESUMO

Gastrointestinal tract (GI) perforations can occur due to various causes such as trauma, iatrogenic factor, infectious condition, peptic ulcer, inflammatory disease, or a neoplasm. Because GI perforations represent an emergency and life-threatening condition, prompt diagnosis and surgical treatment are required in most cases. However, according to the underlying causes of GI perforations, additional treatment strategies may be needed. Adjuvant chemotherapy or immunotherapy may be required in various GI neoplasms such as adenocarcinoma, lymphoma or gastrointestinal stromal tumor. Inflammatory bowel disease is a chronic disease repeating cycle of intermittent, thus appropriate medical treatment and periodic follow-up are also required. Moreover, vascular intervention may have a role in some cases of mesenteric ischemia associated with mesenteric artery occlusion. Recently, computed tomography (CT) has been the first choice for patients with suspected GI perforations, because CT plays an important role in the accurate assessment of the perforation site, the pathology causing the perforation and the ensuing complications. This review will illustrate characteristic CT findings that differentiate underlying pathologies causing GI perforations to help clinicians decision-making regarding an optimal treatment plan.

4.
Eur Radiol ; 30(1): 66-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385051

RESUMO

OBJECTIVES: To investigate possible associations between quantitative apparent diffusion coefficient (ADC) metrics derived from whole-lesion histogram analysis and breast cancer recurrence risk in women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer who underwent the Oncotype DX assay. METHODS: This retrospective study was conducted on 105 women (median age, 48 years) with ER-positive, HER2-negative, node-negative breast cancer who underwent the Oncotype DX test and preoperative diffusion-weighted imaging (DWI). Histogram analysis of pixel-based ADC data of whole tumors was performed, and various ADC histogram parameters (mean, 5th, 25th, 50th, 75th, and 95th percentiles of ADCs) were extracted. The ADC difference value (defined as the difference between the 5th and 95th percentiles of ADCs) was calculated to assess intratumoral heterogeneity. Associations between quantitative ADC metrics and the recurrence risk, stratified using the Oncotype DX recurrence score (RS), were evaluated. RESULTS: Whole-lesion histogram analysis showed that the ADC difference value was different between the low-risk recurrence (RS < 18) and the non-low-risk recurrence (RS ≥ 18; intermediate to high risk of recurrence) groups (0.600 × 10-3 mm2/s vs. 0.746 × 10-3 mm2/s, p < 0.001). Multivariate regression analysis demonstrated that a lower ADC difference value (< 0.559 × 10-3 mm2/s; odds ratio [OR] = 5.998; p = 0.007) and a small tumor size (≤ 2 cm; OR = 3.866; p = 0.012) were associated with a low risk of recurrence after adjusting for clinicopathological factors. CONCLUSIONS: The ADC difference value derived from whole-lesion histogram analysis might serve as a quantitative DWI biomarker of the recurrence risk in women with ER-positive, HER2-negative, node-negative invasive breast cancer. KEY POINTS: • A lower ADC difference value and a small tumor size were associated with a low risk of recurrence of breast cancer. • The ADC difference value could be a quantitative marker for intratumoral heterogeneity. • Whole-lesion histogram analysis of the ADC could be helpful for discriminating the low-risk from non-low-risk recurrence groups.


Assuntos
Neoplasias da Mama/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Algoritmos , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Genes erbB-2 , Humanos , Pessoa de Meia-Idade , Receptores Estrogênicos/metabolismo , Estudos Retrospectivos , Fatores de Risco
5.
BMC Cancer ; 19(1): 1043, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690273

RESUMO

BACKGROUND: Radiological imaging plays a central role in the diagnosis of breast cancer (BC). Some studies suggest MRI techniques like diffusion weighted imaging (DWI) may provide further prognostic value by discriminating between tumors with different biologic characteristics including receptor status and molecular subtype. However, there is much contradictory reported data regarding such associations in the literature. The purpose of the present study was to provide evident data regarding relationships between quantitative apparent diffusion coefficient (ADC) values on DWI and pathologic prognostic factors in BC. METHODS: Data from 5 centers (661 female patients, mean age, 51.4 ± 10.5 years) were acquired. Invasive ductal carcinoma (IDC) was diagnosed in 625 patients (94.6%) and invasive lobular carcinoma in 36 cases (5.4%). Luminal A carcinomas were diagnosed in 177 patients (28.0%), luminal B carcinomas in 279 patients (44.1%), HER 2+ carcinomas in 66 cases (10.4%), and triple negative carcinomas in 111 patients (17.5%). The identified lesions were staged as T1 in 51.3%, T2 in 43.0%, T3 in 4.2%, and as T4 in 1.5% of the cases. N0 was found in 61.3%, N1 in 33.1%, N2 in 2.9%, and N3 in 2.7%. ADC values between different groups were compared using the Mann-Whitney U test and by the Kruskal-Wallis H test. The association between ADC and Ki 67 values was calculated by Spearman's rank correlation coefficient. RESULTS: ADC values of different tumor subtypes overlapped significantly. Luminal B carcinomas had statistically significant lower ADC values compared with luminal A (p = 0.003) and HER 2+ (p = 0.007) lesions. No significant differences of ADC values were observed between luminal A, HER 2+ and triple negative tumors. There were no statistically significant differences of ADC values between different T or N stages of the tumors. Weak statistically significant correlation between ADC and Ki 67 was observed in luminal B carcinoma (r = - 0.130, p = 0.03). In luminal A, HER 2+ and triple negative tumors there were no significant correlations between ADC and Ki 67. CONCLUSION: ADC was not able to discriminate molecular subtypes of BC, and cannot be used as a surrogate marker for disease stage or proliferation activity.

6.
Korean J Radiol ; 20(7): 1167-1175, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31270980

RESUMO

OBJECTIVE: To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp. MATERIALS AND METHODS: Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B. RESULTS: Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups. CONCLUSION: CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.

7.
AJR Am J Roentgenol ; 213(3): 659-666, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31039013

RESUMO

OBJECTIVE. The purpose of this study was to evaluate and compare the diagnostic performance and image quality of low-dose CT performed with adaptive statistical iterative reconstruction (ASIR)-V with those of routine-dose CT with filtered back projection (FBP) in the evaluation of abdominal organ injury. MATERIALS AND METHODS. The study enrolled 197 patients with trauma who underwent multiphase abdominal CT, including routine-dose portal venous phase imaging with FBP and low-dose delayed phase imaging with 50% ASIR-V. The presence of abdominal organ injuries (liver, spleen, pancreas, kidney) was reviewed, and injuries were graded according to American Association for the Surgery of Trauma (AAST) scales. CT detection rates of organ injury and AAST grading with the two protocols were compared by McNemar test. Subjective analysis of image noise and artifacts and objective analysis of CT noise were performed by unpaired t test. RESULTS. Compared with the routine-dose protocol, the low-dose protocol enabled an mean dose reduction of 59.8%. The detection rates and diagnostic performance of AAST grading did not differ significantly between the two protocols (detection rate, p = 0.289; diagnostic performance, p > 0.999). Objective image noise was significantly less with the low-dose protocol than with the routine-dose protocol (p < 0.001). Subjective imaging artifacts were similar between the low-dose and routine-dose protocols (p = 0.539). CONCLUSION. Compared with routine-dose protocol with FBP, low-dose CT with ASIR-V was useful for assessing multiorgan abdominal injury without impairing image quality.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Estudos Retrospectivos
8.
Radiology ; 291(2): 300-307, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30860453

RESUMO

Background Combined minimum apparent diffusion coefficient (ADC) and ADC difference value may improve the diagnostic performance of breast diffusion-weighted imaging (DWI) compared with mean ADC. Purpose To investigate whether ADC parameters at DWI are associated with distant metastasis-free survival in women with invasive breast cancer. Materials and Methods Between 2013 and 2014, 258 consecutive women (mean age ± standard deviation, 50.9 years ± 10.5; age range, 23-85 years) with newly diagnosed invasive breast cancer who underwent preoperative MRI with DWI were evaluated. All DWI examinations were retrospectively reviewed by two radiologists blinded to clinical information. The mean, minimum, and maximum ADCs were measured by manually placing regions of interest within the lesions, and the ADC difference value (the difference between minimum and maximum ADCs) was calculated to evaluate intratumoral heterogeneity. Cox proportional hazards models were used to determine the associations between ADC parameters and distant metastasis-free survival after adjustment for clinical-pathologic factors. Results In 25 of the 258 women (9.7%), distant metastasis developed at a median follow-up of 51 months. The ADC difference value was higher in women with distant metastasis than in those without distant metastasis (mean, 0.743 × 10-3 mm2/sec vs 0.566 × 10-3 mm2/sec, respectively; P < .001). Multivariable Cox proportional hazards analysis showed that a higher ADC difference value (>0.698 × 10-3 mm2/sec) (hazard ratio [HR], 4.5; 95% confidence interval [CI]: 2.0, 10.0; P < .001), presence of axillary node metastasis (HR, 3.3; 95% CI: 1.2, 9.3; P = .02), and estrogen receptor negativity (HR, 2.6; 95% CI: 1.2, 5.7; P = .02) were associated with poorer distant metastasis-free survival. Conclusion A higher apparent diffusion coefficient difference value at diffusion-weighted imaging is associated with poorer distant metastasis-free survival of women with invasive breast cancer. © RSNA, 2019 See also the editorial by Taourel in this issue.


Assuntos
Neoplasias da Mama , Imagem de Difusão por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos , Adulto Jovem
9.
Korean J Radiol ; 20(1): 94-101, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30627025

RESUMO

Objective: To investigate the efficacy of motion-correction algorithm (MCA) in improving coronary artery image quality and measurement accuracy using an anthropomorphic dynamic heart phantom and 256-detector row computed tomography (CT) scanner. Materials and Methods: An anthropomorphic dynamic heart phantom was scanned under a static condition and under heart rate (HR) simulation of 50-120 beats per minute (bpm), and the obtained images were reconstructed using conventional algorithm (CA) and MCA. We compared the subjective image quality of coronary arteries using a four-point scale (1, excellent; 2, good; 3, fair; 4, poor) and measurement accuracy using measurement errors of the minimal luminal diameter (MLD) and minimal luminal area (MLA). Results: Compared with CA, MCA significantly improved the subjective image quality at HRs of 110 bpm (1.3 ± 0.3 vs. 1.9 ± 0.8, p = 0.003) and 120 bpm (1.7 ± 0.7 vs. 2.3 ± 0.6, p = 0.006). The measurement error of MLD significantly decreased on using MCA at 110 bpm (11.7 ± 5.9% vs. 18.4 ± 9.4%, p = 0.013) and 120 bpm (10.0 ± 7.3% vs. 25.0 ± 16.5%, p = 0.013). The measurement error of the MLA was also reduced using MCA at 110 bpm (19.2 ± 28.1% vs. 26.4 ± 21.6%, p = 0.028) and 120 bpm (17.9 ± 17.7% vs. 34.8 ± 19.6%, p = 0.018). Conclusion: Motion-correction algorithm can improve the coronary artery image quality and measurement accuracy at a high HR using an anthropomorphic dynamic heart phantom and 256-detector row CT scanner.


Assuntos
Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Frequência Cardíaca/fisiologia , Coração/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Artefatos , Precisão da Medição Dimensional , Humanos , Movimento (Física) , Movimento/fisiologia , Imagens de Fantasmas
10.
Eur Radiol ; 29(2): 485-493, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30073498

RESUMO

OBJECTIVES: To investigate the value of the whole-lesion histogram apparent diffusion coefficient (ADC) metrics for differentiating low-risk from non-low-risk ductal carcinoma in situ (DCIS). METHODS: The authors identified 93 women with pure DCIS who had undergone preoperative MR imaging and diffusion-weighted imaging from 2013 to 2016. Histogram analysis of pixel-based ADC data of the whole tumour volume was performed by two radiologists using a software tool. The results were compared between low-risk and non-low-risk DCIS. Associations between quantitative ADC metrics and low-risk DCIS were evaluated by receiver operating characteristics (ROC) curve and logistic regression analyses. RESULTS: In whole-lesion histogram analysis, mean ADC and 5th, 50th and 95th percentiles of ADC were significantly different between low-risk and non-low-risk DCIS (1.522, 1.207, 1.536 and 1.854 × 10-3 mm2/s versus 1.270, 0.917, 1.261 and 1.657 × 10-3 mm2/s, respectively; p = .004, p = .003, p = .004 and p = .024, respectively). ROC curve analysis for differentiating low-risk DCIS revealed that 5th percentile ADC yielded the largest area under the curve (0.786) among the metrics of whole-lesion histogram, and the optimal cut-off point was 1.078 × 10-3 mm2/s (sensitivity 80%, specificity 75.9%, p = .001). Multivariate regression analysis revealed that a high 5th percentile of ADC (> 1.078× 10-3 mm2/s; odds ratio [OR] = 10.494, p = .016), small tumour size (≤ 2 cm; OR = 12.692, p = .008) and low Ki-67 status (< 14%; OR = 10.879, p = .046) were significantly associated with low-risk DCIS. CONCLUSIONS: Assessment with whole-lesion histogram analysis of the ADC could be helpful for identifying patients with low-risk DCIS. KEY POINTS: • Whole-lesion histogram ADC metrics could be helpful for differentiating low-risk from non-low-risk DCIS. • A high 5th percentile ADC was a significant factor associated with low-risk DCIS. • Risk stratification of DCIS is important for their management.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Progressão da Doença , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , Carga Tumoral , Adulto Jovem
11.
Breast Cancer Res ; 20(1): 58, 2018 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-29921323

RESUMO

BACKGROUND: Numerous studies have analyzed associations between apparent diffusion coefficient (ADC) and histopathological features such as Ki-67 proliferation index in breast cancer (BC), with mixed results. The purpose of this study was to perform a multicenter analysis to determine relationships between ADC and expression of Ki-67 and tumor grade in BC. METHODS: For this study, data from six centers were acquired. The sample comprises 870 patients (all female; mean age, 52.6 ± 10.8 years). In every case, breast magnetic resonance imaging with diffusion-weighted imaging was performed. The comparison of ADC values in groups was performed by Mann-Whitney U test where the p values are adjusted for multiple testing (Bonferroni correction). The association between ADC and Ki-67 values was calculated by Spearman's rank correlation coefficient. Sensitivity, specificity, negative and positive predictive values, accuracy, and AUC were calculated for the diagnostic procedures. ADC thresholds were chosen to maximize the Youden index. RESULTS: Overall, data of 870 patients were acquired for this study. The mean ADC value of the tumors was 0.98 ± 0.22 × 10- 3 mm2 s- 1. ROC analysis showed that it is impossible to differentiate high/moderate grade tumors from grade 1 lesions using ADC values. Youden index identified a threshold ADC value of 1.03 with a sensitivity of 56.2% and specificity of 67.9%. The positive predictive value was 18.2%, and the negative predictive value was 92.4%. The level of the Ki-67 proliferation index was available for 845 patients. The mean value was 12.33 ± 21.77%. ADC correlated with weak statistical significant with expression of Ki-67 (p = - 0.202, p < 0.001). ROC analysis was performed to distinguish tumors with high proliferative potential from tumors with low expression of Ki-67 using ADC values. Youden index identified a threshold ADC value of 0.91 (sensitivity 64%, specificity 50%, positive predictive value 67.7%, negative predictive value 45.0%). CONCLUSIONS: ADC cannot be used as a surrogate marker for proliferation activity and/or for tumor grade in breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/genética , Imagem de Difusão por Ressonância Magnética , Antígeno Ki-67/genética , Adulto , Idoso , Neoplasias da Mama/fisiopatologia , Proliferação de Células/genética , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estatísticas não Paramétricas
12.
Eur Radiol ; 28(8): 3185-3193, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29713771

RESUMO

OBJECTIVES: To investigate whether quantitative diffusion metrics derived from diffusion tensor imaging (DTI) are associated with histological prognostic factors in breast cancer patients. METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. Between 2016 and 2017, 251 consecutive women (mean age, 53.8 years) with breast cancer (230 invasive, 21 in situ) who underwent preoperative magnetic resonance (MR) imaging with DTI were identified. Diffusion gradients were applied in 20 directions (b values, 0 and 1,000 s/mm2). DTI metrics - mean diffusivity (MD) and fractional anisotropy (FA) - were measured for breast lesions and contralateral normal breast by two radiologists and were correlated with histological findings using the Mann-Whitney U-test and linear regression analysis. RESULTS: MD and FA were significantly lower for breast cancers than for normal fibroglandular tissues (1.03 ± 0.25×10-3 mm2/s vs. 1.60 ± 0.19×10-3 mm2/s, p < 0.001 and 0.29 ± 0.09 vs. 0.33 ± 0.06, p < 0.001, respectively). Significant differences were observed in MD between invasive cancer and ductal carcinoma in situ lesions (p < 0.001). Multivariate linear analysis showed that larger size (>2 cm) (p = 0.007), high histological grade (grade 3) (p = 0.045) and axillary node metastasis (p = 0.009) were significantly associated with lower MD in invasive breast cancer patients. Larger size (p < 0.001) and high histological grade (p = 0.025) were significantly associated with lower FA. CONCLUSIONS: DTI-derived diffusion metrics, such as MD and FA, are associated with histological prognostic factors in breast cancer patients. KEY POINTS: • MD was significantly lower for breast cancers than for normal breast tissues. • FA was significantly lower for breast cancers than for normal breast tissues. • Reduced DTI metrics were associated with poor prognostic factors of breast cancer. • DTI may provide valuable information concerning biological aggressiveness in breast cancer.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anisotropia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
13.
Acta Radiol ; 59(11): 1292-1299, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29758996

RESUMO

Background Non-mass enhancements (NME) with invasive components account for 10-42% of total malignant NMEs. The factors associated with invasiveness on magnetic resonance imaging (MRI) could be useful for clinical assessment and treatment. Purpose To evaluate the clinical significances of the distributions and internal enhancement patterns (IEP) of malignant NMEs on 3-T breast MRI. Material and Methods A total of 448 consecutive women with newly diagnosed breast cancer that had undergone preoperative MRI and surgery between February 2013 and March 2016 were identified. After exclusions, 72 malignant NMEs without a mass in 72 women (mean age = 51.5 years) were included. Two readers independently assessed distributions and IEPs of NME, according to the Breast Imaging Reporting and Data System lexicon fifth edition. Collected data included the presence of invasion and histopathologic factors. Results A clustered ring IEP was significantly associated with invasive cancer (75.0%, P = 0.001, Reader1; 72.9%, P < 0.001, Reader 2), absence of necrosis (79.0%, P < 0.001; 72.1%, P < 0.001, respectively), and high Ki-67 expression (74.2%, P = 0.048; 74.2%, P = 0.003, respectively). A clumped IEP was related to ductal carcinoma in situ (33.3%, P = 0.025; 50.0%, P = 0.001, respectively), absence of lymph node metastasis (24.1%, P = 0.029; 31.5%, P = 0.030, respectively), and presence of necrosis (34.5%, P = 0.003; 44.8%, P = 0.001, respectively). Conclusion The presence of a clustered ring IEP in patients with breast cancer was found to be significantly associated with invasive breast cancer and high Ki-67 expression.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Imagem por Ressonância Magnética/métodos , Sistemas de Informação em Radiologia , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes
14.
Clin Imaging ; 48: 79-85, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29055275

RESUMO

PURPOSE: To explore associations between prognostic factors and subtypes of invasive breast cancer (IBC) and elasticity values using three-dimensional (3D) and two-dimensional (2D) shear-wave elastography (SWE). MATERIALS AND METHODS: Mean elasticity values (kPa) of 121 IBCs were measured using both 3D and 2D SWE. Associations between these values and prognostic factors and subtypes were analyzed using linear regression model. RESULTS: In both 3D and 2D SWE, larger size and presence of lymphovascular invasion were independent factors influencing higher mean elasticity on multivariate analyses (all p values<0.05). CONCLUSIONS: Using either 3D or 2D SWE, higher mean elasticity values are associated with poor prognostic factors of IBC.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Técnicas de Imagem por Elasticidade/métodos , Elasticidade , Imageamento Tridimensional/métodos , Ultrassonografia Mamária/métodos , Adulto , Idoso , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Metástase Linfática/diagnóstico , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
15.
Acta Radiol ; 59(5): 546-552, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28766981

RESUMO

Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B ( P < 0.01). Noise in group A was significantly lower than in group B except for PV and contrast-to-noise ratio were not significantly different in the two groups ( P > 0.05). In addition, radiation dose in group A was significantly lower than in group B ( P < 0.001). Subjective image quality comparison revealed group A was statistically inferior to group B except for subjective image noise. Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.


Assuntos
Flebografia/métodos , Tomografia Computadorizada por Raios X/métodos , Varizes/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem
16.
AJR Am J Roentgenol ; 209(6): 1411-1418, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28834445

RESUMO

OBJECTIVE: The purpose of this study was to analyze the clinicopathologic and immunohistochemical features of invasive breast cancers detected only with digital breast tomosynthesis (DBT), compared with those of cancers detected with both DBT and full-field digital mammography (FFDM). MATERIALS AND METHODS: The medical records of 261 women (108 without and 153 with symptoms) with invasive breast cancers who underwent FFDM and DBT between April 2015 and June 2016 were retrospectively reviewed. To assess detectability, all DBT and FFDM images were reviewed independently by three radiologists blinded to clinicopathologic information. The reference standard was established by an unblinded consensus review of all images. Clinicopathologic and immunohistochemical features were analyzed according to the detectability status. RESULTS: Of the 261 cancers, 223 (85.4%) were detected with both DBT and FFDM (both-detected group). Twenty-four cancers (9.2%) not detected with FFDM (DBT-only group) were classified by DBT as a mass (58.3%), architectural distortion (33.3%), or asymmetry (8.3%). The remaining 14 cancers (5.4%) were not detected with either DBT or FFDM (both-occult group). On multivariate analysis, a dense breast parenchyma (p = 0.007), small tumor size (≤ 2 cm; p = 0.027), and luminal A-like subtype (estrogen receptor positive or progesterone receptor positive or both, human epidermal growth factor receptor 2 negative, and Ki-67 expression < 14%; p = 0.008) were significantly associated with the DBT-only group. For 108 screening-detected cancers, a dense breast parenchyma (p = 0.007) and luminal A-like subtype (p = 0.008) also maintained significance. CONCLUSION: The addition of DBT to FFDM in screening would aid in the detection of less-aggressive subtypes of invasive breast cancers in women with dense breasts.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Mamografia/métodos , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Korean J Radiol ; 18(4): 643-654, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28670159

RESUMO

OBJECTIVE: To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis. MATERIALS AND METHODS: We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. RESULTS: During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CONCLUSION: CMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.


Assuntos
Imagem Cinética por Ressonância Magnética , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Idoso , Área Sob a Curva , Progressão da Doença , Ecocardiografia , Feminino , Gadolínio/química , Ventrículos do Coração/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Miocardite/mortalidade , Miocardite/patologia , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Função Ventricular Esquerda
18.
Radiology ; 284(1): 45-54, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28253106

RESUMO

Purpose To retrospectively investigate the relationship between the kinetic features of breast cancer assessed with computer-aided diagnosis (CAD) at preoperative magnetic resonance (MR) imaging and disease-free survival in patients with primary operable invasive breast cancer. Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. The authors identified 329 consecutive women (mean age, 52.9 years; age range, 32-88 years) with newly diagnosed invasive breast cancer who had undergone preoperative MR imaging and surgery between January 2012 and February 2013. All MR images were retrospectively reviewed by using a commercially available CAD system, and the following kinetic parameters were noted for each lesion: peak enhancement (highest pixel signal intensity in the first series obtained after administration of contrast material), angio-volume (total volume of the enhancing lesion), and delayed enhancement profiles (the proportions of washout, plateau, and persistently enhancing component within a tumor). Cox proportional hazards modeling was used to identify the relationship between CAD-generated kinetics and disease-free survival after adjusting for clinical-pathologic variables. Results A total of 36 recurrences developed at a median follow-up of 50 months (range, 15-55 months). CAD-measured peak enhancement at preoperative MR imaging enabled differentiation between patients with and patients without recurrence (area under the receiver operating characteristic curve = 0.728; 95% confidence interval [CI]: 0.676, 0.775; P < .001). Multivariate Cox analysis showed that a higher peak enhancement (hazard ratio [HR] = 1.001; 95% CI: 1.000, 1.002; P = .004), a higher washout component (HR = 1.029; 95% CI: 1.005, 1.054; P = .017), and lymphovascular invasion at histopathologic examination (HR = 3.011; 95% CI: 1.302, 6.962; P = .010) were associated with poorer disease-free survival. Conclusion Higher values of CAD-measured peak enhancement and washout component at preoperative MR imaging were significantly associated with poorer disease-free survival of patients with primary operable breast cancer. © RSNA, 2017.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico por Computador , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Meios de Contraste , Intervalo Livre de Doença , Feminino , Humanos , Cinética , Mastectomia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Compostos Organometálicos , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
J Magn Reson Imaging ; 45(1): 94-102, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27313102

RESUMO

PURPOSE: To explore the association between quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) and Ki-67 proliferation status in patients with estrogen receptor (ER)-positive invasive breast cancer. MATERIALS AND METHODS: We retrospectively reviewed the records of 88 patients with ER-positive invasive breast cancer who underwent preoperative DCE-MRI and DWI on a 3T scanner. Perfusion parameters (Ktrans , Kep , and Ve ) and apparent diffusion coefficients (ADCs) were recorded, and we correlated these data with the Ki-67 status. The Ki-67 proliferation index was categorized as high (≥14%) or low (<14%). RESULTS: In the high-Ki-67 group, the mean Ktrans was significantly higher (P < 0.001) than that of the low-Ki-67 group, and the mean ADC significantly lower (P < 0.001). However, the mean Kep and Ve values did not differ between the two groups (P = 0.248 and P = 0.055, respectively). Univariate analysis showed that a higher Ktrans (>0.274), a lower ADC (≤0.893 × 10-3 mm2 /s), a larger tumor size (>2 cm), a higher histological grade (grade 3), the presence of axillary metastasis, and positive P53 status were significantly associated with high-Ki-67 status (all P values < 0.05). Of these variables, a higher Ktrans (>0.274; adjusted odds ratio [OR] = 9.027, 95% confidence interval [CI] = 1.929-42.245; P = 0.005) and a higher histological grade (grade 3; adjusted OR = 7.510, 95% CI = 1.305-43.205; P = 0.024) independently predicted a high Ki-67 status. CONCLUSION: Ktrans derived from DCE-MRI is associated independently with the Ki-67 proliferation status in patients with ER-positive invasive breast cancer. LEVEL OF EVIDENCE: 4 J. Magn. Reson. Imaging 2017;45:94-102.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Antígeno Ki-67/metabolismo , Imagem por Ressonância Magnética/métodos , Receptores Estrogênicos/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Meios de Contraste , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Clin Imaging ; 40(3): 345-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27133665

RESUMO

PURPOSE: To investigate the value of diffusion-weighted imaging (DWI) for differentiating gallbladder adenocarcinoma from adenoma, and predicting histologic grades of gallbladder adenocarcinoma. MATERIALS AND METHODS: Fourty-three gallbladder adenocarcinomas and 8 adenomas were included. We compared apparent diffusion coefficient (ADC) values between adenocarcinoma and adenoma, and ADC values of gallbladder adenocarcinoma among the histologic grade. RESULTS: Gallbladder adenocarcinoma (1.041×10(-3)mm(2)/s) showed significantly lower ADC values than adenoma (2.039×10(-3)mm(2)/s) (P<.001). Well-differentiated adenocarcinoma (1.290×10(-3)mm(2)/s) showed significantly higher ADC values than higher-grades (1.104×10(-3) and 0.915×10(-3)mm(2)/s in moderately- and poorly-differentiated, respectively) (P<.001). CONCLUSION: DWI can help to differentiate gallbladder adenocarcinoma from adenoma, and well-differentiated from higher-grade adenocarcinoma.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Adenocarcinoma/patologia , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos
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