Dual-modal computer-assisted evaluation of axillary lymph node metastasis in breast cancer patients on both real-time elastography and B-mode ultrasound

PurposeTo propose a computer-assisted method for quantifying the hardness of an axillary lymph node on real-time elastography (RTE) and its morphology on B-mode ultrasound; and to combine the dual-modal features for differentiation of metastatic and benign axillary lymph nodes in breast cancer patients.Materials and methodsA total of 161 axillary lymph nodes (benign, n = 69; metastatic, n = 92) from 158 patients with breast cancer were examined with both B-mode ultrasound and RTE. With computer assistance, five morphological features describing the hilum, size, shape, and echogenic uniformity of a lymph node were extracted from B-mode, and three hardness features were extracted from RTE. Single-modal and dual-modal features were used to classify benign and metastatic nodes with two computerized classification approaches, i.e., a scoring approach and a support vector machine (SVM) approach. The computerized approaches were also compared with a visual evaluation approach.ResultsAll features exhibited significant differences between benign and metastatic nodes (p < 0.001), with the highest area under the receiver operating characteristic curve (AUC) of 0.803 and the highest accuracy (ACC) of 75.2% for a single feature. The SVM on dual-modal features achieved the largest AUC (0.895) and ACC (85.7%) among all methods, exceeding the scoring (AUC = 0.881; ACC = 83.6%) and the visual evaluation methods (AUC = 0.830; ACC = 84.5%). With the leave-one-out cross validation, the SVM on dual-modal features still obtained an ACC as high as 84.5%.ConclusionDual-modal features can be extracted from RTE and B-mode ultrasound with computer assistance, which are valuable for discrimination between benign and metastatic lymph nodes. The SVM on dual-modal features outperforms the scoring and visual evaluation methods, as well as all methods using single-modal features. The computer-assisted dual-modal evaluation of lymph nodes could be potentially used in daily clinical practice for assessing axillary metastasis in breast cancer patients.     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Shear wave elastography versus real-time elastography on evaluation thyroid nodules: A preliminary study

Objective

To comparatively evaluate shear wave elastography (SWE) and real-time elastography (RTE) in distinguishing malignant from benign thyroid nodules.

Methods

49 patients with 64 focal thyroid nodules were enrolled and underwent SWE and RTE before surgery. SWE elasticity indices (mean, minimum and maximum value of 2-mm region of interest) of nodules were measured. For RTE, elastograms were assessed by Rago criteria and nodules with scores of 4 or 5 were classified as suspicious for malignancy. Surgery histopathologic results were adopted as diagnostic standard.

Results

Of the 64 nodules, 19 were papillary thyroid carcinomas and 45 were benign. SWE indices were significantly higher in malignant than benign nodules (P < 0.05). Areas under the ROC curves (AUC) of SWE parameters were 0.840, 0.831 and 0.788, which were not significantly different from that of RTE showed as 0.880 (P = 0.148–0.482). When the most accurate cut-off, 38.3 kPa for mean value was applied to predict malignancy, the diagnostic specificity, sensitivity, accuracy, positive predictive value and negative predictive value of SWE and RTE were 68.4% versus 79.0%, 86.7% versus 84.4%, 81.3% versus 78.1%, 68.4% versus 64.7% and 86.7% versus 83.3%, respectively (P = 0.683–1.000).

Conclusion

SWE as a promising tool can be performed in differentiating thyroid nodules with comparable results to RTE.     

Real-time ultrasound elastography: an assessment of enlarged cervical lymph nodes

Objectives

To determine the efficacy of real-time elastography (RTE), compared with our previously proposed prediction model, in the detection of malignancy in cervical lymph nodes (LNs).

Methods

One hundred and thirty-one patients underwent ultrasound-guided fine needle aspiration biopsy (ultrasound FNAB) after ultrasound and RTE evaluation. The formula of the RTE scoring system was a four-point visual scale, based on a previously determined model. The formula of the prediction model was: $ 0.06\times \left( {\mathrm{age}} \right)+4.76\times \left( {{{{\mathrm{short}-\mathrm{axis}}} \left/ {{\mathrm{long}-\mathrm{axis}\;\mathrm{ratio}}} \right.}} \right)+2.15\times \left( {\mathrm{internal}\;\mathrm{echo}} \right)+1.80\times \left( {\mathrm{vascular}\;\mathrm{pattern}} \right) $ . An extended model was constructed with four previous predictors and elasticity scores, using a logistic regression model.

Results

Final histology revealed 77 benign and 54 malignant LNs. In the elasticity score system, sensitivity was 66.7 %, specificity was 57.1 %, the positive predictive value (PPV) was 52.2 % and the negative predictive value (NPV) was 71.0 %. In the prediction model system, sensitivity was 79.6 %, specificity was 92.2 %, the PPV was 87.8 % and the NPV was 86.6 %. When the extended and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) was 0.94 and 0.95, respectively (P?>?0.05).

Conclusions

Qualitative RTE offers no additional value over conventional ultrasound in predicting malignancy in cervical LNs.

Key Points

? An ultrasound system can help in the assessment of cervical lymph nodes. ? Grey-scale and power Doppler ultrasound remain fundamental for neck nodal evaluation. ? Qualitative real-time elastography provided no additional value compared with current prediction models.     

Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values

Purpose

To assess the role of 2D-shear wave elastography (2D-SWE) in differentiating benign from malignant focal breast lesions (FBLs), providing new vendor-specific cutoff values.

Methods

158 FBLs (size: 3.5–50 mm) detected in 151 women (age: 21–87 years) were prospectively evaluated by means 2D-SWE. For each lesion, an expert radiologist assessed US BI-RADS category and calculated the following four 2D-SWE parameters: (1) elasticity maximum (E_max); (2) mean elasticity (E_mean); (3) minimum elasticity (E_min); (4) elasticity ratio (E_ratio). US-guided core-biopsy was considered as standard of reference for all the FBLs classified as BI-RADS 4 or 5. For each 2D-SWE parameter, the optimal cutoff value for a diagnostic test was calculated using the Youden method. Diagnostic performance of the US BI-RADS and 2D-SWE parameters was calculated accordingly.

Results

83/158 (52.5%) FBLs were benign and 75/158 (47.5%) were malignant. Statistically significant higher stiffness values were observed in malignant FBLs for all 2D-SWE parameters than in benign ones (p?<?0.001). 2D-SWE cutoff values were 82.6 kPa, 66.0 kPa and 53.6 kPa, respectively, for E_max, E_mean, E_min and 330.8% for E_ratio. The 2D-SWE parameter showing the best diagnostic accuracy was E_max (85.44%). Considering US BI-RADS 3 (n?=?60) and 4a (n?=?32) FBLs, E_max and E_mean showed the best diagnostic accuracy (85.87% for both), without a statistically significant decrease in sensitivity (p?=?0.7003 and p?=?1, respectively).

Conclusion

Our study provides new vendor-specific cutoff values for 2D-SWE, suggesting its possible clinical use in the adjunctive assessment of category US-BI-RADS 3 and 4a breast masses.

     

Elastography ultrasound for breast lesions: fat-to-lesion strain ratio vs gland-to-lesion strain ratio

Objective

To compare the diagnostic performance of the fat-to-lesion strain ratio (FLR) and gland-to-lesion strain ratio (GLR) in the diagnosis of breast lesions.

Methods

This was an institutional ethics committee approved prospective study. One hundred and ninety-three breast lesions in 193 women (mean age, 46.03?±?13.60 years, range 18–82 years) were examined with conventional and elastographic US. Both the FLR and GLR of the lesions were calculated. The elasticity scores of the lesions were also evaluated using the five-point elasticity scoring system. For diagnostic performance, the sensitivity, specificity and receiver operating characteristic (ROC) analysis were obtained.

Results

Seventy lesions were malignant and 123 were benign. Both the FLR and GLR of the lesions were significantly higher in malignant cases than in benign ones (P?P?=?0.009, P?=?0.029, respectively). However, there was no significant difference in the Az value between the FLR and the elasticity score (P?=?0.443).

Conclusion

The FLR yielded better diagnostic performance than GLR in breast lesions; the fatty tissue was better than glandular tissue as the reference normal tissue for calculating strain ratio in breast elastography.

Key Points

? FLR was higher than GLR in both malignant and benign breast lesions. ? Both FLR and GLR were higher in malignant than in benign breast lesions. ? FLR yielded better diagnostic performance than GLR in breast lesions.     

A comparison of long-term clinical outcomes of accelerated partial breast irradiation using interstitial brachytherapy as per GEC-ESTRO,ASTRO, updated ASTRO,and ABS guidelines

PurposeThe purpose of this study is to evaluate long-term clinical outcomes of women treated with accelerated partial breast irradiation (APBI) using multicatheter interstitial brachytherapy (MIB-APBI) with risk groups defined by Groupe Européen de Curie-thérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO), American Society for Radiation Oncology (ASTRO), updated ASTRO, and American Brachytherapy Society (ABS) guidelines and to elucidate the most appropriate guideline that could differentiate outcomes among its risk groups.Methods and MaterialsTwo hundred forty women underwent MIB-APBI during July 2000 to March 2013. Comparisons of long-term clinical outcomes (local control [LC], disease-free survival [DFS], cause-specific survival [CSS], and overall survival [OAS]) stratified by the risk groups proposed by the aforementioned patient selection guidelines were carried out on a prospectively maintained database.ResultsAt a median follow-up of 114 months, 10-year LC, DFS, and OAS were 90%, 81%, and 83.5%, respectively, for the entire group. There was no statistically significant difference in the LC rates for risk groups by ESTRO, ASTRO, updated ASTRO and ABS guidelines. The 10-year DFS and OAS for GEC-ESTRO low-, intermediate-, and high-risk group was 75%, 88%, and 60% (p = 0.02) and 86%, 93%, and 62% (p = 0.001), respectively. Ten-year DFS and OAS in the ABS 2018–acceptable and ABS 2018–unacceptable group were 78% and 67% (p = 0.01) and 88% and 69% (p = 0.001), respectively. No significant difference in any of the outcomes was observed with risk groups suggested by ASTRO or updated ASTRO consensus guidelines.ConclusionsNone of the current patient selection guidelines for APBI could differentiate LC (main APBI endpoint) among its risk groups, whereas GEC-ESTRO and ABS guideline could differentiate DFS and OAS.     

乳腺癌根治术后双弧VMAT与IMRT计划的剂量学比较

目的 比较乳腺癌根治术后双弧的容积旋转调强放射治疗(VMAT)与5野的静态调强放射治疗(IMRT)2种计划之间的剂量学差异,评估VMAT技术在乳腺癌根治术后的剂量学特点与应用能力.方法 选取28例乳腺癌根治术后患者(左侧10例,右侧18例),分别制定双90度弧段的VMAT与5野的IMRT 2种计划,主要的计划评估参数为靶区的肿瘤控制概率(TCP)、适形指数(CI)、均匀指数(HI)以及接受相应处方剂量水平照射体积百分比V₉₅、V₁₁₀,危及器官(OAR)评估包括患侧肺的正常组织并发症概率(NTCP)、D_mean、V₅、V₂₀、V₃₀,心脏的NTCP值、D_mean、V₂₅,健侧乳腺的D_mean、机器跳数(MU)以及治疗时间.结果 VMAT计划与IMRT计划的TCP值分别为(96±2)%、(90±2)%(t=-6.28,P<0.01);HI值分别为0.15±0.04,0.22±0.02(t=13.29,P<0.05);肿瘤位于左侧时,心脏NTCP值在VMAT计划与IMRT计划中分别为(1.0±0.12)%,(1.7±0.13)%(t=2.14,P<0.05);肿瘤位于右侧时,2种计划心脏的NTCP差异无统计学意义,平均剂量分别为(3.27±0.26)、(6.0±0.47)Gy(t=9.21, P<0.01);VMAT计划在MU少于IMRT计划(t=9.58,P<0.01),治疗时间短于IMRT计划(t=8.40,P<0.05).结论 乳腺癌根治术后,VMAT计划具有更强的临床应用能力,且表现出更优的剂量学特点.     

Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours

Purpose

This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours.

Materials and methods

Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions.

Results

Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57±69.29 kPa and 54.49±33.70 kPa) than did benign lesions (59.00±45.3 kPa and 36.64±26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79].

Conclusions

Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.     

Early outcomes of abbreviated multi-fractionated brachytherapy schedule for cervix cancer during COVID-19 pandemic

PURPOSEBrachytherapy (BT) for cervix cancer was listed as a level I priority and reduced number of implants and multiple fractions were recommended during COVID-19 pandemic. We present early clinical outcome of this approach.METHODS AND MATERIALSPatients treated with (chemo)radiotherapy and BT with single implant and multiple fractions BT were included. Treatment protocol included 3−5 fractions of 5−8.5 Gy with an aim to achieve point A dose of 70 Gy EQD2_10Gy (or HRCTV dose of >80 Gy EQD2_10Gy) in those undergoing intracavitary (IC) and HRCTV dose >85 Gy EQD2 10Gy in patients undergoing Intracavitary-Interstitial (IC/IS) whereas maintaining bladder (B2cc), rectum (R2cc), sigmoid (S 2cc) doses of 90, 75, and 75 Gy EQD2_3Gy. Time to event analysis was used to report oncological endpoints. Toxicity was reported using crude proportions.RESULTSFrom April 2020 to March, 2021, 64 patients with stage IB2-IV received single implant and multi-fraction BT after external radiation of 45 Gy/25 fractions/5 weeks. Only 76.7% (n = 49) received concurrent chemotherapy. Median overall treatment time (OTT) was 56 days (38−131 days). Overall, 62.5% (n = 40) patients received IC and 37.5% (n = 24) received IC+IS. The median HRCTV was 34.7 cc (IQR 25−41). Median (IQR) point A dose, HRCTV D90, B2cc, R2cc, and S2cc for those undergoing IC was 74 Gy (71−78), 80 Gy (73−84), 86 Gy (82−89), 70 Gy (65−74), 65 Gy (59−73) respectively. For the IC+IS cohort, HRCTV D90, B2cc, R2cc, and S2cc was 84 Gy (78−89 Gy), 89 Gy (86−92), 70 Gy (67−74), 68 Gy (59−76). At a median follow-up of 16 months (5−27) the 2-year local control, pelvic control, cause specific and overall survival was 88%, 85.3%, 92.2%, and 81.3% respectively. Late gastrointestinal and genitourinary grade ≥III toxicities were 14% and 1.5% each.CONCLUSIONSAbbreviated BT outcomes are encouraging for oncological outcomes despite delays in overall treatment time and omission of chemotherapy. Further mature follow up is needed.     

Diagnostic value of real-time elastography in the assessment of hepatic fibrosis in patients with liver iron overload

Objective

The objective of our prospective monocentric work was to determine the diagnostic value of real-time elastography (RTE) in the assessment of liver fibrosis in patients with iron overload, using transient elastography (TE) as reference standard.

Methods

Sixty-seven consecutive patients with MRI detectable iron overload (T2* < 6.3 ms) were enrolled. TE and RTE were performed on the same day as MRI. Elastograms were acquired by an experienced operator and analyzed by calculating the elastic ratio between perihepatic soft tissues and liver parenchyma. An elliptical ROI of 1 cm² (Z₁) was positioned in the liver parenchyma and a smaller elliptical ROI of 2 mm² (Z₂) was positioned in a homogeneously soft (red) region of the diaphragm, which was considered as internal control to calculate the elastic ratio Z₂/Z₁.

Results

Seven patients were excluded because of invalid TE or RTE examinations. The remaining 60 patients were 57% males and 43% females (mean age: 42 [21–76] years), including 37 homozygous-β-thalassemics, 13 patients with β-thalassemia intermedia, 6 with primary hemochromatosis, and 4 with myelodysplastic syndrome. Increasing elastic ratios were significantly correlated with increasing TE values (r = 0.645, 95% CI 0.468–0.772, P < 0.0001). The mean elastic ratios for each METAVIR group were as follows: F0/1 = 1.9 ± 0.4; F2 = 2.2 ± 0.4; F3 = 2.9 ± 0.5; F4 = 3.2 ± 0.4. The diagnostic accuracy of RTE for F ≥ 2 evaluated by AUC-ROC analysis was 0.798 (95% CI 0.674–0.890). The diagnostic accuracy of RTE for F ≥ 3 was 0.909 (95% CI 0.806–0.968). At a cut-off ≥ 2.75, RTE showed a sensitivity of 70% (95% CI 45.7–88.1) and a specificity of 97.5% (95% CI 86.8–99.9).

Conclusions

In patients with MRI-detectable liver iron-overload RTE allows to discriminate between F0/1–F2 and F3–F4 with a reasonable diagnostic accuracy.     

Detection of Contralateral Breast Cancer Using Diffusion-Weighted Magnetic Resonance Imaging in Women with Newly Diagnosed Breast Cancer: Comparison with Combined Mammography and Whole-Breast Ultrasound

ObjectiveTo compare the screening performance of diffusion-weighted (DW) MRI and combined mammography and ultrasound (US) in detecting clinically occult contralateral breast cancer in women with newly diagnosed breast cancer.Materials and MethodsBetween January 2017 and July 2018, 1148 women (mean age ± standard deviation, 53.2 ± 10.8 years) with unilateral breast cancer and no clinical abnormalities in the contralateral breast underwent 3T MRI, digital mammography, and radiologist-performed whole-breast US. In this retrospective study, three radiologists independently and blindly reviewed all DW MR images (b = 1000 s/mm² and apparent diffusion coefficient map) of the contralateral breast and assigned a Breast Imaging Reporting and Data System category. For combined mammography and US evaluation, prospectively assessed results were used. Using histopathology or 1-year follow-up as the reference standard, cancer detection rate and the patient percentage with cancers detected among all women recommended for tissue diagnosis (positive predictive value; PPV₂) were compared.ResultsOf the 30 cases of clinically occult contralateral cancers (13 invasive and 17 ductal carcinoma in situ [DCIS]), DW MRI detected 23 (76.7%) cases (11 invasive and 12 DCIS), whereas combined mammography and US detected 12 (40.0%, five invasive and seven DCIS) cases. All cancers detected by combined mammography and US, except two DCIS cases, were detected by DW MRI. The cancer detection rate of DW MRI (2.0%; 95% confidence interval [CI]: 1.3%, 3.0%) was higher than that of combined mammography and US (1.0%; 95% CI: 0.5%, 1.8%; p = 0.009). DW MRI showed higher PPV₂ (42.1%; 95% CI: 26.3%, 59.2%) than combined mammography and US (18.5%; 95% CI: 9.9%, 30.0%; p = 0.001).ConclusionIn women with newly diagnosed breast cancer, DW MRI detected significantly more contralateral breast cancers with fewer biopsy recommendations than combined mammography and US.     

Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer

PurposeTo evaluate clinical outcome and feasibility of a four-dimensional image-guided adaptive brachytherapy concept in patients with locally recurrent endometrial cancer.Methods and MaterialsForty-three patients with locally recurrent endometrial cancer were included. Treatment consisted of conformal external beam radiotherapy followed by a boost using pulsed-dose-rate brachytherapy (BT). Large tumors were treated with MRI-guided interstitial BT. Small tumors were treated with CT-guided intracavitary BT. The planning aim (total external beam radiotherapy and BT) for high-risk clinical target volume was D₉₀ > 80 Gy, whereas constraints for organs at risk were D_2cc ≤ 90 Gy for bladder and D_2cc ≤ 70 Gy for rectum, sigmoid, and bowel in terms of equivalent dose in 2 Gy fractions.ResultsMedian high-risk clinical target volume was 18 cm³ (range, 0–91). D₉₀ was 82 Gy (range, 77–88). D_2cc to bladder, rectum, and sigmoid were 67 Gy (range, 50–81), 67 Gy (range, 51–77), and 55 Gy (range, 44–68), respectively. Median followup was 30 months (6–88). Two-year local control rate was 92% (standard error [SE], 5). Disease-free survival rate and overall survival rate was 59% (SE, 8) and 78% (SE, 7), respectively. Patients with low- to intermediate-risk for recurrence had a 2-year disease-free survival rate of 72% (SE, 9) compared with 42% (SE, 12) in patients with high risk for recurrence (p = 0.04). Late morbidity Grade 3 was recorded in 5 (12%) patients.ConclusionsFour-dimensional image-guided adaptive brachytherapy is feasible in locally recurrent endometrial cancer. Local control rate is good. Systemic control remains a problem in patients with high risk for recurrence.     

Differentiation of benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional shear-wave elastography

Objectives

To prospectively compare the diagnostic performances of two-dimensional (2D) and three-dimensional (3D) shear-wave elastography (SWE) for differentiating benign from malignant breast masses.

Methods

B-mode ultrasound and SWE were performed for 134 consecutive women with 144 breast masses before biopsy. Quantitative elasticity values (maximum and mean elasticity in the stiffest portion of mass, E_max and E_mean; lesion-to-fat elasticity ratio, E_rat) were measured with both 2D and 3D SWE. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity of B-mode, 2D, 3D SWE and combined data of B-mode and SWE were compared.

Results

Sixty-seven of the 144 breast masses (47 %) were malignant. Overall, higher elasticity values of 3D SWE than 2D SWE were noted for both benign and malignant masses. The AUC for 2D and 3D SWE were not significantly different: E_mean, 0.938 vs 0.928; E_max, 0.939 vs 0.930; E_rat, 0.907 vs 0.871. Either 2D or 3D SWE significantly improved the specificity of B-mode ultrasound from 29.9 % (23 of 77) up to 71.4 % (55 of 77) and 63.6 % (49 of 77) without a significant change in sensitivity.

Conclusion

Two-dimensional and 3D SWE performed equally in distinguishing benign from malignant masses and both techniques improved the specificity of B-mode ultrasound.

Key Points

? Shear-wave elastography (SWE) is increasingly used during ultrasound of the breast ? 2D and 3D SWE performed equally in distinguishing benign from malignant masses ? Either SWE method, combined with B-mode, outperformed B-mode ultrasound alone ? Quantitative elasticity was greater for 3D than 2D SWE for all masses     

Synthesis and biodistribution of lipophilic and monocationic gallium radiopharmaceuticals derived from N,N′-bis(3-aminopropyl)-N,N′-dimethylethylenediamine: potential agents for PET myocardial imaging with 68Ga

IntroductionIn locations that lack nearby cyclotron facilities for radionuclide production, generator-based ⁶⁸Ga radiopharmaceuticals might have clinical utility for positron emission tomography (PET) studies of myocardial perfusion and other physiological processes.MethodsThe lipophilic and monocationic ⁶⁷Ga-labeled gallium chelates of five novel hexadentate bis(salicylaldimine) ligands the bis(salicylaldimine), bis(3-methoxysalicylaldimine), bis(4-methoxysalicylaldimine), bis(6-meth,oxysalicylaldimine), and bis(4,6-dimethoxysalicylaldimine) of N,N′-bis(3-aminopropyl)-N,N′-dimethylethylenediamine (BAPDMEN), were prepared. The structure of the unlabeled [Ga(4-MeOsal)₂BAPDMEN]⁺PF₆^? salt was determined by X-ray crystallography, and the biodistribution of each of the ⁶⁷Ga-labeled gallium chelates was determined in rats following intravenous administration and compared with the biodistribution of [⁸⁶Rb]rubidium chloride.ResultsThe [Ga(4-MeOsal)₂BAPDMEN]⁺PF₆^? complex exhibited the expected pseudo-octahedral N₄O₂^2? coordination sphere about the Ga³⁺ center with a trans disposition of the phenolate oxygen atoms. All five ⁶⁷Ga radiopharmaceuticals were found to afford the desired myocardial retention of the radiogallium. The [^67/68Ga][Ga(3-MeOsal)₂BAPDMEN]¹⁺ radiopharmaceutical appears to have the best properties for myocardial imaging, exhibiting 2% of the injected dose in the heart 1 min and 2 h postinjection and very high heart/nontarget ratios (heart/blood ratios of 7.6±1.0 and 54±10 at 1 and 120 min, respectively; heart/liver ratios of 1.8±0.4 and 39±3 at 1 and 120 min, respectively).ConclusionsMost of these new agents, particularly [^67/68Ga][Ga(3-MeOsal)₂BAPDMEN]¹⁺, would appear superior to previously reported bis(salicylaldimine) ligands of N,N′-bis(3-aminopropyl)ethylenediamine as candidates for PET imaging of the heart with ⁶⁸Ga.     

快速旋转调强与五野动态调强在乳腺癌 保乳术后放疗中的剂量学比较

目的 比较乳腺癌保乳术后RapidArc计划与五野动态调强(5F-IMRT)计划的剂量学差异。方法 选择8例左侧乳腺癌保乳术后女性患者,处方剂量为50 Gy/ 25次。分别设计RapidArc计划与5F-IMRT计划。比较两种计划的靶区适形度指数、均匀性指数、靶区覆盖度和危及器官的受照剂量体积,同时比较两组计划实施时的治疗时间和机器跳数。结果 在两种计划的靶区比较中,RapidArc计划的靶区适形度指数为(0.88±0.03),高于5F-IMRT计划的(0.79±0.02)(t=8.28,P<0.05);RapidArc计划的均匀性指数为(9.01±0.73),优于5F-IMRT计划的(10.44±1.08)(t=-2.73,P<0.05)。两组计划在同侧肺受照剂量体积比较中RapidArc计划的D_mean、V₁₀、V₂₀、V₃₀小于5F-IMRT计划(t=-7.53、-7.20、-8.39、-7.80,P<0.05),但RapidArc计划中的V₅较5F-IMRT计划增加了约16% (t=5.67,P<0.05);心脏的受照剂量体积比较中RapidArc计划中的D_mean、V₅、V₁₀均高于5F-IMRT(t=10.46、28.76、5.40,P<0.05),但在RapidArc计划中心脏的V₃₀低于5F-IMRT (t=-6.12,P<0.05)。对侧肺和对侧乳腺的V₅在RapidArc计划中明显高于5F-IMRT计划 (肺:t=21.50,P<0.05;乳腺:t=5.44,P<0.05)。RapidArc计划中机器跳数减少了25%,平均治疗时间节省了60%。结论 乳腺癌保乳术后RapidArc计划与5F-IMRT计划比较提高了靶区的适形度和均匀度,减少了高剂量区的受照体积,降低了机器跳数,缩短了治疗时间,但增加了正常组织低剂量区的受照体积。     

三维适形、逆向调强及旋转调强放疗技术对部分乳腺外照射的剂量学比较

目的 比较三维适形(3 D-CRT)、逆向调强(IMRT)及旋转调强(V-MAT)3种部分乳腺外照射(EB-PBI)治疗计划的剂量学差异.方法 选择定位影像资料完整的12例保乳术后行EB-PBI患者,每例患者分别设计3D-CRT、IMRT、V-MAT 3种治疗计划,比较3种计划的靶区剂量分布、危及器官受照剂量及所需机器跳数(MU)和治疗时间.结果 3D-CRT计划的靶区适形度最差,V-MAT计划的处方剂量靶区覆盖率及靶区剂量均匀性最差.3D-CRT计划中患侧肺V5、V10和平均剂量低,而患侧肺V30高;计划间患侧肺V20差异无统计学意义;V-MAT计划中15、20和25 Gy剂量包绕的同侧正常乳腺体积少;对于心脏V5、平均剂量及最大剂量、对侧肺平均剂量、甲状腺平均和最大剂量,IMRT＞ V-MAT＞ 3D-CRT,计划间两两比较差异均有统计学意义(z=-2.94 ～ -2.09,P＜0.05).3D-CRT、IMRT和V-MAT计划所需MU值分别为417.6 ±34.4、772.8±54.4和631.0±109.0,计划间两两比较差异均有统计学意义(z=-2.93、-2.76、-2.93,P＜0.05);V-MAT计划施照时间短.结论 对于部分乳腺癌的放射治疗,旋转调强计划在降低患侧靶区外正常乳腺组织受照射剂量和减少治疗时间方面优势比较明显.     

Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4

Objectives

To evaluate the diagnostic performance of shear-wave elastography (SWE) for breast cancer and to determine whether the integration of SWE into BI-RADS with subcategories of category 4 improves the diagnostic performance.

Methods

A total of 389 breast masses (malignant 120, benign 269) in 324 women who underwent SWE before ultrasound-guided core biopsy or surgery were included. The qualitative SWE feature was assessed using a four-colour overlay pattern. Quantitative elasticity values including the lesion-to-fat elasticity ratio (E_ratio) were measured. Diagnostic performance of B-mode ultrasound, SWE, or their combined studies was compared using the area under the ROC curve (AUC).

Results

AUC of E_ratio (0.952) was the highest among elasticity values (mean, maximum, and minimum elasticity, 0.949, 0.939, and 0.928; P?=?0.04) and AUC of colour pattern was 0.947. AUC of combined studies was significantly higher than for a single study (P?<?0.0001). When adding SWE to category 4 lesions, lesions were dichotomised according to % of malignancy: 2.1 % vs. 43.2 % (category 4a) and 0 % vs. 100 % (category 4b) for E_ratio and 2.4 % vs. 25.8 % (category 4a) for colour pattern (P?<?0.05).

Conclusions

Shear-wave elastography showed a good diagnostic performance. Adding SWE features to BI-RADS improved the diagnostic performance and may be helpful to stratify category 4 lesions.

Key points

? Quantitative and qualitative shear-wave elastography provides further diagnostic information during breast ultrasound. ? The elasticity ratio (E _ratio ) showed the best diagnostic performance in SWE. ? E _ratio and four-colour overlay pattern significantly differed between benign and malignant lesions. ? SWE features allowed further stratification of BI-RADS category 4 lesions.     

Decay data of 141Ce

A 4πβ-gamma coincidence system and several efficiency calibrated semiconductor spectrometers were used to determine the following ¹⁴¹Ce/¹⁴¹Pr decay data: 1. The β-transition probability to the 145 keV level of ¹⁴¹Pr, b₁. 2. The total conversion coefficient of the 145 keV transition to the ground state of ¹⁴¹Pr, α_T. 3. The gamma-ray emission probability of the 145 keV photons, P_γ. The results are b₁ = 0.697(6), α_T = 0.452(8), P_γ = 0.480(5). The value of b₁ is in agreement with most of the values reported in the literature for this quantity. The value found for α_T is higher than all experimental values determined previously but agrees well with the theoretically calculated value for an M1 transition with 0.48% E2 admixture (α_T = 0.4565). The value for P_γ agrees with the value determined by Hansen et al. (1979), P_γ = 0.482(3). In addition, emission probabilities of K and L x-rays following the decay of ¹⁴¹Ce are determined experimentally.