数字乳腺断层融合技术的辐射剂量分析

目的探讨数字乳腺断层融合技术(DBT)的平均腺体剂量(AGD)、曝光条件与不同乳腺腺体类型、乳腺压迫厚度之间的相关性。方法收集2019年1月至2019年12月采用数字乳腺X线机进行乳腺检查共计160个病例,每例患者检查先行常规数字乳腺X线((DM))检查,包括头尾位(craniocaudal,CC)和内外斜位(mediolateral oblique,MLO)双体位投照,后在同一压迫条件下完成DBT相同体位的检查扫描。比较不同乳腺腺体类型、乳腺压迫厚度下平均剂量、管电压、管电流间的差异,并进一步比较同一体位下DM与DBT腺体剂量的差异。结果当乳腺压迫力度和厚度相同时,随着腺体含量增加,AGD、管电流逐渐增加(r=0.487,P=0.001;r=0.436,P=0.04),与管电压无相关性(r=0.018,P=0.616)。随着腺体厚度的加大,AGD、管电压、管电流增加,呈密切正相关(r=0.769,r=0.679,r=0.817,P均0.01),同一压迫状态下DM腺体平均剂量(1.17±0.39) m Gy,DBT腺体平均剂量(1.80±0.53) mGy,差异有统计学意义(P0.01)。结论随着乳腺腺体组织致密程度越高、乳腺压迫厚度越大,其AGD和管电流就越大,同一压迫状态下DBT腺体辐射剂量大于DM。     

数字乳腺断层融合技术的辐射剂量分析

目的探讨数字乳腺断层融合技术(DBT)的平均腺体剂量(AGD)、曝光条件与不同乳腺腺体类型、乳腺压迫厚度之间的相关性。方法收集2019年1月至2019年12月采用数字乳腺X线机进行乳腺检查共计160个病例,每例患者检查先行常规数字乳腺X线((DM))检查,包括头尾位(craniocaudal,CC)和内外斜位(mediolateral oblique,MLO)双体位投照,后在同一压迫条件下完成DBT相同体位的检查扫描。比较不同乳腺腺体类型、乳腺压迫厚度下平均剂量、管电压、管电流间的差异,并进一步比较同一体位下DM与DBT腺体剂量的差异。结果当乳腺压迫力度和厚度相同时,随着腺体含量增加,AGD、管电流逐渐增加(r=0.487,P=0.001;r=0.436,P=0.04),与管电压无相关性(r=0.018,P=0.616)。随着腺体厚度的加大,AGD、管电压、管电流增加,呈密切正相关(r=0.769,r=0.679,r=0.817,P均0.01),同一压迫状态下DM腺体平均剂量(1.17±0.39)m Gy,DBT腺体平均剂量(1.80±0.53) m Gy,差异有统计学意义(P0.01)。结论随着乳腺腺体组织致密程度越高、乳腺压迫厚度越大,其AGD和管电流就越大,同一压迫状态下DBT腺体辐射剂量大于DM。     

数字乳腺断层摄影定性诊断乳腺肿块

目的观察数字乳腺断层摄影(DBT)定性诊断乳腺肿块的效能。方法回顾性分析85例女性乳腺肿块患者,以组织病理学结果为诊断金标准,采用受试者工作特征(ROC)曲线分析全数字化乳腺X线摄影(FFDM)、DBT及FFDM+DBT的定性诊断效能。结果于85例共检出89个乳腺肿块,病理诊断良性病变56个、恶性病变33个。FFDM、DBT及FFDM+DBT定性诊断乳腺肿块的敏感度分别为69.64%、87.50%、和87.50%,特异度分别为69.70%、78.79%和84.85%,准确率分别为69.66%、84.27%和86.52%,AUC分别为0.75[95%CI(0.65,0.84)]、0.92[95%CI(0.84,0.97)]和0.93[95%CI(0.86,0.98)];DBT、FFDM+DBT的敏感度、特异度、准确率及AUC均大于FFDM(P均0.05),DBT与FFDM+DBT差异均无统计学意义(P均0.05)。结论 DBT可定性诊断乳腺肿块,且其诊断效能高于FFDM。     

不同临床及影像学特征对良恶性乳头溢液疾病鉴别诊断价值分析

目的 探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。 方法 回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例（14.2%）,乳腺良性疾病200例（85.8%）。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。 结果 血性溢液（P=0.008）、乳腺X线摄影伴可疑恶性钙化（P<0.001）、MRI表现为段样强化（P=0.003）、流出型时间-信号强度曲线（P=0.023）的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低（57.6%）,劣于超声检查（87.9%,P=0.012）及MRI检查（93.9%,P=0.001）。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查（P=0.004,P<0.001）。结论 对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。     

乳腺X线摄影对临床体检及超声检查阴性、X线摄影可疑病灶用外科干预的指导意义

目的:探讨乳腺影像报告及数据系统(BI-RADS)对临床体检及超声检查阴性、乳腺X线摄影可疑阳性的乳房病灶用外科干预的指导意义。方法:对乳腺X线摄影提示存在可疑病灶,而临床无法扪及明显肿块且超声检查阴性的病人,进行乳腺X线立体定位,作手术活检或真空辅助微创旋切活检,以明确可疑病灶的病理诊断。使用卡方检验或确切概率法检验,比较不同BI-RADS分类间恶性疾病发生率的差异;组间两两比较采用卡方分割法。结果:180例病灶中,BI-RADS分类属4A类者为92例,4B类者为64例,4C类者为24例。有23例病灶证实为恶性病变,其中2例(8.7%)为4A类,9例(39.1%)为4B类,12例(52.3%)为4C类。卡方检验发现,不同BI-RADS分类组之间,恶性病例的发生率有统计学差异(P<0.001)。结论:对于乳腺X线摄影检查为唯一阳性结果的乳腺病灶,BI-RADS分类系统对是否应予外科干预有指导意义。BI-RADS属4A类病灶可行短期随访;属4B或4C类病灶需进一步作外科活检以明确诊断。     

超低剂量螺旋CT诊断乳腺肿块性质的应用价值

目的:探索超低剂量螺旋CT乳腺肿块影像学表现,分析其乳腺肿块性质判断的应用价值.方法:回顾性分析68例经手术病理证实的女性乳腺疾病患者术前超低剂量螺旋CT扫描影像资料,并与病理学检查结果进行对比分析,资料进行统计学处理.结果:超低剂量螺旋CT扫描诊断乳腺肿块与病理比较:恶性符合率93.7％,良性符合率100.0％,总符合率97.0％;二者恶性检出率比较,差异无统计学意义(P＞0.05).结论:超低剂量螺旋CT扫描与病理对照乳腺肿诊断符合率高,辐射剂量明显减少,能够满足临床的需要.     

X线钼靶摄影与超声诊断乳腺微钙化灶的对比研究

目的：比较X线钼靶摄影与超声在乳腺微钙化灶诊断中的价值。方法：收集伴随微钙化灶（经X线钼靶摄影确诊）的乳腺良性、恶性疾病患者117例,分析超声对乳腺微钙化的检出率;比较X线钼靶摄影与超声检查对乳腺微钙化灶病例诊断的敏感性、特异性及准确性。结果：乳腺微钙化的超声检出率为66.7%,其中乳腺恶性病灶的微钙化超声检出率为87.5%,乳腺良性病变的微钙化灶超声检出率为33.3%,超声诊断乳腺微钙化灶病例的敏感性、特异性和准确性分别为69.4%、86.7%和76.1%,X线钼靶摄影分别为75.0%、73.3%、74.3%,两者联合应用为90.2%、91.1%、90.5%。结论：X线钼靶摄影与超声相比,前者具有较高的敏感性,后者具有较高的特异性,而两者联合应用可提高对乳腺微钙化灶病例诊断的准确率,对于乳腺癌的早期诊断具有较高的临床实用价值。     

血管造影机装配复合滤过板对辐射剂量的影响

目的探讨血管造影机装配复合滤过板对辐射剂量的影响以及复合滤过板的正确使用方法。方法在血管造影机管球X线出口分别放置0.1mm铜＋1.0mm铝和0.2mm铜＋1.0mm铝厚度的复合滤过板,用11cm和21cm组织等效固体水模模拟人体。联合使用Multi-Detector半导体空气电离室和MagicMax-Meter测量软件,采集血管造影机透视和造影时的辐射剂量和设备曝光参数,对比分析使用滤过板前后数据的变化和对软射线的滤过效果。结果滤过板及体模的厚度均与mA、ms、mAs、TF及HVL等测定值变化呈正相关,与吸收剂量率（D.）变化呈负相关。放置滤过板可使血管机透视和造影时的D.值下降幅度分别达到32.00%～43.48%和43.63%～72.07%。结论放置滤过板可明显降低射线吸收剂量。     

超声联合钼靶X线对乳腺小结节病灶诊断价值对比分析

目的:探讨超声联合钼靶X线对乳腺小结节病灶诊断价值.方法:32例女性乳腺癌患者均行手术并经病理学证实,采用彩色超声检查和铝靶X线检查对乳腺肿块进行诊断与鉴别诊断.结果:钼靶和超声的总体敏感性分别为71.9%,87.5%,超声诊断的敏感性明显好于钼靶X线诊断(P<0.05);同时两种方法联合使敏感性达96.9%,而漏诊率降低至3.1%.结论:乳腺超声成像和钼靶X线摄影联合应用可提高对乳腺小结节病灶诊断的敏感性,值得临床推广.     

不同MRI扫描序列对乳腺肿块诊断价值的研究

目的:探讨不同MRI扫描序列在乳腺肿块诊断中的价值.方法:对21例临床怀疑乳腺癌的患者行MRI扫描,扫描序列包括T<,1>WI/TSE、T<,2>/WI/TSE、STIR、DWIBS及动态增强THRIVE序列,结果与病理结果对照.结果:T<,1>WI/TSE、T<,2>WI/TSE、STIR、DWIBS及动态增强THRIVE序列对26个乳腺病灶的检出率分别为53.85%(14/26)、65.38%(17/26)、80.77%(21/26)、88.46%(23/26)、100%(26/26).动态增强扫描对病灶进行定性诊断明显优于其他序列,其敏感性、特异性、准确性分别为100%、77.78%、92.31%.结论:动态增强THRIVE序列能清晰显示乳腺肿块、明确肿块性质,为外科医生提供更详细的影像学资料.DWIBS和STIR序列比常规T<,1>WI/TSE、T<,2>WI/TSE显示乳腺肿块更敏感.     

经锥光束乳腺CT引导下穿刺不同体模模拟乳腺肿物活检的可行性

目的对比分析不同体模模拟经锥光束乳腺CT(CBBCT)引导下乳腺肿物穿刺活检的可行性。方法在CBBCT引导下分别对不同体模(硅胶乳腺、煮熟土豆、圆形茄子和芒果)深浅部位的靶目标(腊肠块模拟肿瘤)进行穿刺活检,统计其准确率及成本。结果同一体模深部与浅部穿刺准确率差异均无统计学意义(P均>0.05)。硅胶乳腺穿刺准确率为92.50%(37/40),土豆为81.25%(78/96),茄子为72.92%(70/96),芒果为61.54%(32/52)。结论CBBCT引导下体模穿刺活检的准确率较高,以煮熟土豆性价比最高。     

Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis

PurposeWe conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone.MethodsMedline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs).ResultsThirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD = −0.1/1000 screens, 95 % CI = −0.4 to 0.2, p = 0.557, I² = 0 %), but lower recall rate (RD = −0.56 %, 95 % CI = −1.03 to −0.08, p = 0.022, I² = 90 %) and lower biopsy rate (RD = −0.33 %, 95 % CI = −0.56 to −0.10, p = 0.005, I² = 78 %). Compared with DM, SM/DBT improved CDR (RD = 2.0/1000 screens, 95 % CI = 1.4 to 2.6, p < 0.001, I² = 63 %) and reduced recall rate (RD = −0.95 %, 95 % CI = −1.91 to −0.002, p = 0.049, I² = 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD = 0.1/1000 screens, 95 % CI = −0.6 to 0.8, p = 0.836, I² = 71 %) and biopsy rate (RD = −0.05 %, 95 % CI = −0.35 to 0.24, p = 0.727, I² = 93 %).ConclusionsScreening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. SM/DBT improves CDR when compared with DM, but they have little difference in ICR. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose.     

Breast tomosynthesis: Dosimetry and image quality assessment on phantom

PurposeTo evaluate using phantom study the average glandular dose (AGD) and image quality in breast tomosynthesis.Materials and methodsThe study was performed with a full-field digital mammography system (Mammomat Inspiration^®, Siemens, Erlangen, Germany) combined with tomosynthesis equipment (3D). For AGD evaluation, polymethyl methacrylate (PMMA) plates and a dosimeter were used to directly measure the absorbed doses in 2D and in 3D. The doses were then compared to the doses displayed on the equipment using the Mann–Whitney test. Three phantoms, accredited for 2D digital mammography (MTM 100, ACR RMI 156, BR3D), were imaged three times in 2D then in 3D. For each acquisition, the AGD was recorded. For image quality assessment, scores, defined by the rate of visible inserts, obtained for each acquisition both in 2D and in 3D, and for each phantom, were compared (Kruskall–Wallis and post-hoc Dunn tests).ResultsThere was no significant difference between the measured and displayed AGD, both in 2D and in 3D imaging (P > 0.05). With identical acquisition parameters, AGD were significantly greater in 3D than in 2D P < 0.01). For phantoms MTM 100 and ACR RMI 156, there was no significant difference between the rate of visible inserts in 2D and in 3D (P = 0.06 and P = 0.36, respectively). However for phantom BR3D, the rate was significantly higher in 3D than in 2D (P < 0.0001).ConclusionDoses are significantly greater in 3D than in 2D. With tomosynthesis, out of the three phantoms tested, only phantom BR3D showed a higher rate of visible inserts.     

Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: Results of the Trento DBT pilot evaluation

Background/aimThe Trento screening program transitioned to digital breast tomosynthesis (DBT) screening based on evidence that DBT improves breast cancer (BC) detection compared to mammography; an evaluation of the transition to DBT is reported in this pilot study.MethodsProspective implementation of DBT screening included women aged ≥50 years who attended the Trento program for biennial screening. DBT screening included DBT acquisitions with synthesized 2D-images. A historical cohort of women who attended the program (January 2013–October 2014) and received digital mammography (DM) provided a comparison group. Independent double-reading (with a third arbitrating read for discordance) was used for DBT and DM screening. Screening outcomes included cancer detection rate (CDR/1000 screens), percentage of screens recalled to assessment (recall%), interval cancer rate (ICR/1000 screens) at 2-year follow-up, and screening sensitivity. Rate ratios (RR) and 95% confidence interval (95%CI) examined outcomes for DBT versus DM screening.ResultsFrom women aged 50–69 years who accepted an invitation to screening (October 2014–October 2016) 46,343 comprised the DBT-screened group: amongst these 402 BCs (includes 50 ductal carcinoma in-situ (DCIS)) were detected (CDR 8.67/1000), whereas 205 BCs (includes 33 DCIS) were detected amongst 37,436 DM screens (CDR 5.48/1000) [RR for CDR:1.58 (1.34–1.87)]. Recall% was lower for DBT (2.55%) than DM (3.21%) [RR:0.79 (0.73–0.86)]. Compared to DM, DBT screening increased CDR for stage I-II BC, for all tumour size and grade categories, and for node-negative BC, but did not increase CDR for DCIS. Estimated ICR for DBT was 1.1/1000 whereas ICR for DM was 1.36/1000 [RR:0.81 (0.55–1.19)]. Screening sensitivity was 88.74% for DBT versus 80.08% for DM [RR:1.11 (0.94–1.31)].ConclusionDBT significantly improved early-detection measures but did not significantly reduce ICR (relative to DM screening), suggesting that it could add benefit as well as adding over-detection in population BC screening.     

Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.     

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

To compare diagnostic performance of contrast‐enhanced dual‐energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast‐enhanced MRI (DCE‐MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3‐5 at imaging or clinically suspicious). CEDM, DBT, and DCE‐MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two‐dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE‐MRI. DCE‐MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE‐MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE‐MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE‐MRI. Dynamic information obtained by time‐intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.     

Dose reduction with iterative reconstruction: Optimization of CT protocols in clinical practice

ObjectivesTo create an adaptable and global approach for optimizing MDCT protocols by evaluating the influence of acquisition parameters and Iterative Reconstruction (IR) on dose reduction and image quality.Materials and methodsMDCT acquisitions were performed on quality image phantom by varying kVp, mAs, and pitch for the same collimation. The raw data were reconstructed by FBP and Sinogram Affirmed Iterative Reconstruction (SAFIRE) with different reconstruction kernel and thickness. A total of 4032 combinations of parameters were obtained. Indices of quality image (image noise, NCT, CNR, SNR, NPS and MTF) were analyzed. We developed a software in order to facilitate the optimization between dose reduction and image quality. Its outcomes were verified on an adult anthropomorphic phantom.ResultsDose reduction resulted in the increase of image noise and the decrease of SNR and CNR. The use of IR improved these indices for the same dose without affecting NCT and MTF. The image validation was performed by the anthropomorphic phantom. The software proposed combinations of parameters to reduce doses while keeping indices of the image quality adequate. We observed a CTDIvol reduction between −44% and −83% as compared to the French diagnostic reference levels (DRL) for different anatomical localization.ConclusionThe software developed in this study may help radiologists in selecting adequate combinations of parameters that allows to obtain an appropriate image with dose reduction.     

Systematic review of 3D mammography for breast cancer screening

This review investigated the relative performance of digital breast tomosynthesis (DBT) (alone or with full field digital mammography (FFDM) or synthetic digital mammography) compared with FFDM alone for detecting breast cancer lesions in asymptomatic women. A systematic review was carried out according to systematic reviewing principles provided in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A protocol was developed a priori. The review was registered with PROSPERO (number CRD42014013949). Searches were undertaken in October 2014. Following selection, five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1). Both European studies found lower false positive rates for individual readers. One found a lower recall rate based on conditional recall. The second study was not designed to compare post-arbitration recall rates between FFDM and DBT + FFDM. One European study presented data on interval cancer rates; sensitivity and specificity for DBT + FFDM were both higher compared to FFDM. One large multicentre US study showed a higher cancer detection rate for DBT + FFDM, while two smaller US studies did not find statistically significant differences. Reductions in recall and false positive rates were observed in the US studies in favour of DBT + FFDM. In comparison to FFDM, DBT, as an adjunct to FFDM, has a higher cancer detection rate, increasing the effectiveness of breast cancer screening. Additional benefits of DBT may also include reduced recalls and, consequently, reduced costs and distress caused to women who would have been recalled.     

迭代算法与辐射剂量对低剂量胸部CT图像质量的影响

目的应用胸部模型评价iDOSE4迭代重建算法和不同辐射剂量对低剂量胸部CT图像的噪声和对比噪声比(CNR)的影响。方法应用64排螺旋CT,采用3种管电流(30mAs、50mAs、70mAs)、2种管电压(80kV、100kV)扫描胸部模型,应用滤波反投影(FBP)和iDOSE4 L3、L6算法对原始图像进行重建;由2名放射科医师测量重建图像上ROI的CT值,计算平均噪声和CNR;应用重复测量方差分析比较不同辐射剂量和不同重建算法下图像的CT值和图像质量的差异。结果不同辐射剂量及重建算法组合下,肺野内空气和胸廓均质CT值差异均无统计学意义(P0.05)。随着辐射剂量增加,同一重建算法下平均噪声逐渐降低,CNR逐渐增高;相同辐射剂量下,FBP、iDOSE4 L3、L6重建算法的平均噪声逐渐降低,CNR逐渐增高。结论改变辐射剂量和(或)重建算法不会影响CT值测量的准确性。采用iDOSE4算法能降低较低剂量图像的平均噪声,提高图像质量。