对比增强能谱乳腺X线摄影的辐射剂量分析

背景与目的：对比增强能谱乳腺X线摄影(contrast-enhanced spectral mammography,CESM)是近几年推出的一项新技术,它是基于常规乳腺X线摄影的一项检查技术。该研究通过对低能图与CESM两种影像检查方法的平均腺体剂量进行比较,对CESM检查方法的辐射剂量进行分析。方法：收集143例临床可触及乳腺肿块的患者,根据腺体类型进行分类,其中脂肪型(a)7例,散在纤维腺体型(b)31例,不均匀致密型(c)76例,极度致密型(d)29例;根据病变部位进行分类,其中右侧乳腺肿块70例,左侧乳腺肿块64例,双侧乳腺肿块9例;年龄分布小于40岁有27例,41~50岁有51例,51~60岁有50例,61~70岁有15例。对患者进行划分,比较各腺体类型、健侧或患侧乳腺及不同年龄段的低能图与CESM两种影像检查方法的平均腺体剂量。结果：共计143例患者,CESM检查的AGD较低能图的AGD高26.22%,差异存在统计学意义(P<0.05)。不同乳腺腺体类型的CESM和低能图曝光剂量组内差异均有统计学意义(P<0.05);对CESM和低能图的曝光剂量组间比较时,a、b、c和d型腺体类型的AGD分别增加了26.05%、25.92%、26.82%和24.93%,可见c型腺体的AGD增幅最大,d型腺体的AGD增幅最少(P<0.05)。CESM检查时患侧乳腺的AGD较健侧乳腺的AGD高4.15%,差异有统计学意义(P<0.05)。各年龄段中CESM和低能图的AGD值组内、组间差异均有统计学意义(P<0.05),其中两个患者数较多的年龄段41~50岁、51~60岁的组间两两比较差异有统计学意义(P<0.05)。结论：CESM影像检查方法的辐射剂量略高于低能图,不同乳腺腺体类型、病变部位及年龄段之间均有差异,但仍是一种安全、可靠的检查技术,临床可根据实际需要开展应用。     

内窥镜、超声和X线检查是上消化道疾病合理的互补诊断系统

线的范畴,因胆管、胰管经造影剂充盈后再作X线片诊断。内窥镜可作为带入造影剂检查的辅助工具,超声内镜既有超声又有内镜的双重功能。某些现代化检查手段,如核磁共振、阴电子发射扫描术或同位素扫描等尽管对胃肠疾病诊断有重要价值,但不能视为经典的X线方法。我们的目的是,对出血性小肠肿瘤、胃泌素瘤、食管癌和胃癌患者提出新的诊断策略和作出重要的术前分期。     

CESM病灶-背景实质信号增强比对乳腺疾病的诊断价值

目的:探讨对比增强能谱乳腺X线摄影(contrast-enhanced spectral mammography, CESM)病灶-背景实质信号增强比(LBSER)对乳腺良恶性病变的定量诊断价值。方法:回顾性分析我院临床可疑乳腺疾病112例患者临床资料,所有患者行手术病理或组织穿刺病理活检证实,且术前均行CESM检查。分析病灶的CESM影像学表现,并采用ROI定量分析方法,测量CESM图像病灶中央区及边缘区LBSER值,包括早期增强比及延迟增强比,比较乳腺恶性组与乳腺良性组间LBSER值的差异。采用受试者工作特征(ROC)曲线分析CESM及LBSER对乳腺良恶性病变的诊断效能。结果:112例患者中共117个乳腺病变,其中恶性52个(恶性组),良性65个(良性组),早期恶性病灶中央区、边缘区LBSER值明显高于良性病灶组,具有显著统计学意义(P均<0.001),延迟期恶性病灶中央区、边缘区LBSER值高于良性病灶组,具有统计学意义(P均<0.05)。CESM诊断敏感度、特异度、准确率分别为85.54%、80.00%、82.91%。以恶性病变早期中央区LBSER值的95%可信区...     

CT在膀胱和前列腺肿瘤诊断中的应用

CT是近年来X线诊断学方面的新技术,随着CT的不断改进,逐渐应用在其它器官和系统。作者利用CT 检查,对13名膀胱肿瘤和12名前列腺肿瘤患者肿瘤的诊断和肿瘤浸润的程度进行观察。膀胱和前列腺肿癌患者CT 检查时采用统一的方法。检查前晚作清洁洗肠,检查当日排尿后留置导尿管,在膀胱内注入15%的造影剂30～40毫升。然后用灌洗橡皮球在直肠内注入5～10%的造影剂10毫升。进入CT 检查室后,膀胱内再注入100～150cm~(?)氧气,至患者有尿意感,关闭尿管。在检查膀胱和前     

钍造影剂与肝癌的关系

流行病学研究表明,乙型肝炎病毒携带率与肝癌高发病密切相关。钍造影剂(一种1930～1951年使用的 X 线造影剂),已知由于二氧化钍贮存于肝组织诱发肝癌。肝组织平均剂量率是25拉德/年。在德国钍造影剂研究中,调查了注射钍造影剂后3年以上的1964名造影剂携带者的死亡原因:18%死于原发性肝癌。用3年半以上时间检查了325名钍造影剂接受者和214名对照者血清。以测定 HBsAg、抗-HBs、抗-HBc 出现的频率,和是否这些肝癌病人慢性乙型肝炎病毒(HBV)感染率较高。作者的目的     

CESM与MRI评价乳腺癌新辅助化疗疗效的价值比较

目的:比较增强光谱钼靶(CESM)和磁共振成像(MRI)在乳腺癌新辅助化疗疗效评估中的临床应用价值。方法:纳入我院2018 年1月至2019 年 5 月经病理证实的42 例乳腺癌新辅助化疗患者作为研究对象。所有患者在新辅助化疗前后均进行CESM和MRI检查，评估新辅助化疗疗效，分析检验两种检查方法与病理学的一致性，并比较两者的敏感度、特异度、准确度、阳性预测值、阴性预测值差异。结果:CESM检查的客观缓解率（ORR）为81.0%，与病理学的一致性为0.741，MRI检查的客观缓解率为78.6%，与病理学的一致性为0.797，二组之间差异无明显统计学意义(P>0．05)。CESM检查的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为1、0.88、0.90、0.66、1，MRI为1、0.91、0.93、0.73、1。结论:在评价乳腺癌新辅助化疗疗效方面，CESM 的检查性能与MRI相当，具有较好的应用前景。     

95例乳腺肿块X线检查与超声检查对比分析

目的　分析乳腺X线摄片检查与超声检查诊断乳腺肿块的价值。方法　对 95例乳腺肿块均进行乳腺X线摄片检查和超声检查 ,其中乳腺癌 5 4例 ,良性肿块 41例 ,并与术后病理相对照。结果　乳腺良性肿块超声检查的准确率明显高于X线检查(P <0 .0 5 )。结论　对乳腺良性肿块的诊断超声检查优于X线摄片检查。     

早期周围型肺癌的X线与CT诊断分析

目的:分析早期周围型肺癌的X线与CT征像特点,探讨X线与CT检查在早期周围型肺癌诊断中的作用.方法:对65例直径＜3cm,经手术病理证实的周围型肺癌的X线胸片及CT扫描征象进行回顾性分析.对两种检查方法的定性准确率进行统计学检验.结果:分叶征、毛刺征、空气支气管征、血管集束征及胸膜凹陷征为早期周围型肺癌的基本征象.对病灶的定性诊断CT扫描明显优于普通X线检查(x=5.47 P＜0.025).结论:胸部X线检查是发现病变的基本首选方法,发现病变后进行CT扫描对早期周围型肺癌的确诊有重要意义,熟悉并掌握早期周围型肺癌的基本X线及CT征象是提高肺癌早期诊断水平的关键.     

早期周围型肺癌的X线与CT诊断分析

目的:分析早期周围型肺癌的X线与CT征像特点,探讨X线与CT检查在早期周围型肺癌诊断中的作用。方法:对65例直径<3cm,经手术病理证实的周围型肺癌的X线胸片及CT扫描征象进行回顾性分析。对两种检查方法的定性准确率进行统计学检验。结果:分叶征、毛刺征、空气支气管征、血管集束征及胸膜凹陷征为早期周围型肺癌的基本征象。对病灶的定性诊断CT扫描明显优于普通X线检查(x=5.47 P<0.025)。结论:胸部X线检查是发现病变的基本首选方法,发现病变后进行CT扫描对早期周围型肺癌的确诊有重要意义,熟悉并掌握早期周围型肺癌的基本X线及CT征象是提高肺癌早期诊断水平的关键。     

数字乳腺X线摄影应用研究进展

乳腺断层摄影是通过多点投照获得多个层面的重建图像,这种技术能够提高病灶的检出率和诊断的准确性,降低筛查回叫率。在乳腺疾病的诊断与乳腺癌的筛查中均起着重要作用。双能量乳腺增强摄影检查时需给患者注入碘造影剂,并通过高低能量两次曝光获得标准能量图和高低能量减影图,后者能显示有异常的强化区域。这种技术仅用于诊断性检查,跟常规的乳腺X线检查或常规X线检查加超声组合相比,其检出乳腺癌的敏感性更高;与增强乳腺MRI相比,对主病灶判断的特异性较高,敏感性则相当。     

Practical uses of contrast‐enhanced spectral mammography in daily work: A pictorial review

Contrast‐enhanced spectral mammography (CESM) has a number of uses including the work‐up of inconclusive findings on mammography, assessment of breast symptoms, cancer staging, evaluation of response to neoadjuvant chemotherapy and recently as an alternative to magnetic resonance imaging (MRI) in high‐risk screening. CESM can be swiftly incorporated into the workflow of busy breast clinics. We share our experiences with CESM at a large breast assessment centre in Western Australia.     

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

Background: Evaluating the tumor response to neoadjuvant chemotherapy is key to planning further therapy of breast cancer. Our study aimed to evaluate the effectiveness of low-energy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 63 female patients were qualified for our retrospective analysis. Low-energy and subtraction CESM images just before the beginning of NAC and as a follow-up examination 2 weeks before the end of chemotherapy were compared with one another and assessed for compliance with the postoperative histopathological examination (HP). The response to preoperative chemotherapy was evaluated based on the RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Results: Low-energy images tend to overestimate residual lesions (6.28 mm) and subtraction images tend to underestimate them (2.75 mm). The sensitivity of low-energy images in forecasting CR amounted to 33.33%, while the specificity was 92.86%. In the case of subtraction CESM, the sensitivity amounted to 85.71% and the specificity to 71.42%. Conclusions: CESM is characterized by high sensitivity in the assessment of CR after NAC. The use of only morphological assessment is insufficient. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions.     

The Usefulness of Spectral Mammography in Surgical Planning of Breast Cancer Treatment—Analysis of 999 Patients with Primary Operable Breast Cancer

Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.     

Contrast-enhanced spectral mammography: Does mammography provide additional clinical benefits or can some radiation exposure be avoided?

The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) with mammography (MG) and combined CESM + MG in terms of detection and size estimation of histologically proven breast cancers in order to assess the potential to reduce radiation exposure. A total of 118 patients underwent MG and CESM and had final histological results. CESM was performed as a bilateral examination starting 2 min after injection of iodinated contrast medium. Three independent blinded radiologists read the CESM, MG, and CESM + MG images with an interval of at least 4 weeks to avoid case memorization. Sensitivity and size measurement correlation and differences were calculated, average glandular dose (AGD) levels were compared, and breast densities were reported. Fisher’s exact and Wilcoxon tests were performed. A total of 107 imaging pairs were available for analysis. Densities were ACR1: 2, ACR2: 45, ACR3: 42, and ACR4: 18. Mean AGD was 1.89 mGy for CESM alone, 1.78 mGy for MG, and 3.67 mGy for the combination. In very dense breasts, AGD of CESM was significantly lower than MG. Sensitivity across readers was 77.9 % for MG alone, 94.7 % for CESM, and 95 % for CESM + MG. Average tumor size measurement error compared to postsurgical pathology was ?0.6 mm for MG, +0.6 mm for CESM, and +4.5 mm for CESM + MG (p < 0.001 for CESM + MG vs. both modalities). CESM alone has the same sensitivity and better size assessment as CESM + MG and was significantly better than MG with only 6.2 % increase in AGD. The combination of CESM + MG led to systematic size overestimation. When a CESM examination is planned, additional MG can be avoided, with the possibility of saving up to 61 % of radiation dose, especially in patients with dense breasts.     

Diagnostic Value of Contrast-Enhanced Spectral Mammography for Screening Breast Cancer: Systematic Review and Meta-analysis

Background

Contrast-enhanced spectral mammography (CESM) is a new image examination technology that has developed over the past few years. As CESM technology keeps improving, a current meta-analysis review is needed to systematically evaluate the potential diagnostic value of CESM.

Prediction of Underestimation Using Contrast-Enhanced Spectral Mammography in Patients Diagnosed as Ductal Carcinoma In Situ on Preoperative Core Biopsy

BackgroundTo assess the performance of contrast-enhanced spectral mammography (CESM) for the prediction of DCIS underestimation in comparison with mammography, breast US, and breast MRI.Patients and MethodsWe prospectively enrolled patients diagnosed with DCIS on preoperative core biopsy. Visibility, lesion type, and extent on each imaging modality, CESM gray values (CGV) were evaluated. Pathologic features of core biopsy and surgery were recorded. Chi-square or Fisher's exact test were used for univariate analysis. Multivariate logistic regression analysis was used to find independent predictors for DCIS underestimation and receiver operating characteristic (ROC) curve analysis was performed.ResultsA total of 113 lesions in 108 patients were analyzed (50 pure DCIS; 63 underestimated DCIS). Visibility on mammography, breast US, CESM, and breast MRI were 44%, 76%, 58%, and 80% for pure DCIS, and 73%, 81%, 86%, and 92% for underestimated DCIS. Tumor extents on surgical pathology of pure and underestimated DCIS were 1.11 ± 1.35 cm and 2.61 ± 2.09 cm. On multivariate analysis, nuclear grade and suspected invasion on core biopsy, visibility on mammography, and extent on breast MRI were independent factors for the model 1, whereas nuclear grade on core biopsy, extent on CESM, and mean CGV on MLO-recombined image were independent factors for the model 2. Area under ROC curve (AUC) was 0.843 for model 1 including breast MRI, whereas AUC was 0.823 for model 2 including CESM, which didn't show a significant difference (P = .968).ConclusionFor detecting underestimated DCIS, CESM was superior to mammography and breast US, and comparable to breast MRI.     

Diagnostic accuracy of contrast-enhanced spectral mammography in comparison to conventional full-field digital mammography in a population of women with dense breasts

Background

Contrast-enhanced spectral mammography to compare clinical efficacy of contrast-enhanced spectral mammography (CESM) and conventional digital mammography (MMG) with histopathology as gold standard in dense breasts.

Patients and methods

A total of 143 breasts of 72 women who underwent CESM and MMG between 2011 and 2014 at Showa University Hospital were analyzed.

Results

129 (90.2 %) of 143 breasts revealed dense breasts on MMG. 58 (40.6 %) of 143 breasts were diagnosed with breast cancer at histopathology. The remaining 85 breasts were diagnosed with benign findings after image assessments and/or core needle biopsy. CESM revealed 8 false-negative cases among 58 breast cancer cases (sensitivity 86.2 %) and 5 false-positive cases (specificity 94.1 %). Accuracy was 90.9 %. Conventional MMG was assessed true positive in 31 of 58 breast cancer cases (sensitivity 53.4 %) and false positive in 12 cases (specificity 85.9 %). Accuracy was 72.7 %. Sensitivity (p < 0.001), specificity (p = 0.016) and accuracy (p < 0.001) were significantly higher on CESM compared to MMG. MMG missed malignancy in 27 breasts. Of these, 25 were dense breasts. Of these 25, 20 (80.0 %) breasts were positive on CESM.

Conclusion

These findings suggest that CESM offers superior clinical performance compared to MMG. Use of CESM may decrease false negatives especially for women with dense breasts.

     

Is contrast‐enhanced spectral mammography (CESM) helpful in differentiating diabetic mastopathy from breast carcinoma?

Diabetic mastopathy (DM) is a rare benign inflammatory disease of the breast, which nevertheless gives suspicious image of malignancy by breast ultrasound and mammography. MRI studies of this disease have indicated both nonspecific enhancement and non‐enhancement of the lesion, depending on its degree of lymphocytic infiltration. This is the first case report discussing the appearances of DM on CESM, a novel mammographic technique.