数字化乳腺摄影的临床应用价值

目的 探讨数字化乳腺摄影在临床工作中的应用价值.资料与方法 按顺序抽取接受数字化乳腺摄影和传统屏片乳腺摄影检查的各500例患者的影像资料,就其图像病变显示率、摄片质量及照射剂量进行对比评价.结果 (1)数字化乳腺摄影与传统屏片乳腺摄影对病变显示率的比较如下:微小钙化分别为26%和11.2%(P=0.000),肿块分别为15.2%和10.8%(P=0.039),结构扭曲分别为18%和8.8%(P=0.000),皮肤、乳头影改变分别为4.8%和1.8%(P=0.008).两组差异有统计学意义.(2)照射剂量及重检率比较:数字化乳腺摄影照射剂量较传统屏片乳腺摄影减少,因设备因素引起的重检率为0;传统屏片乳腺摄影因设备凶素引起的重检率为1.4%.结论 数字化乳腺摄影检查技术及图像的病变显示率均优于传统屏片乳腺摄影.数字化乳腺摄影系统操作简便、成像快捷、辐射较低,具有较高的临床应用价值.     

数字化乳腺摄影中的微钙化对临床触诊阴性乳腺癌的诊断意义

目的探讨数字化乳腺摄影中微钙化对临床触诊阴性乳腺癌的诊断价值。方法回顾性分析212例临床触诊阴性而数字化乳腺摄影发现微钙化患者的临床及影像学资料,所有病例均经手术或病理证实,其中乳腺癌131例,乳腺良性病变81例。着重对微钙化的形态分型(根据Le Gal乳腺微钙化分型,Ⅰ型:环形钙化;Ⅱ型:形态规整的小点状钙化;Ⅲ型:泥沙状钙化;Ⅳ型:形态不规则的点状钙化;Ⅴ型:蠕虫样钙化)、特征进行分析,以比较其在良、恶性病变中的差异。数字化乳腺摄影的诊断采用美国放射学会推荐的乳腺影像报告和数据系统。结果乳腺微钙化在良性病变中多为环状、规则细点状,散在分布,密度较高;微钙化在恶性病变中多为泥沙状、不规则颗粒状、蠕虫状、簇状分布,密度较低。乳腺微钙化的形态、大小、数量、密度、均匀性、密集度及其分布在良、恶性病变中存在统计学差异(P<0.05)。结论微钙化对乳腺癌(尤其是临床触诊阴性的乳腺癌)的诊断具有重要意义。     

数字乳腺摄影在乳腺病变诊断中的临床应用分析

目的 探讨数字乳腺钼靶摄影在乳腺病变诊断中的应用及其临床价值.方法 分析我院收治的86例乳腺肿块的患者,均行数字乳腺钼靶摄影及病理检查,比较分析二者的结果.结果 与手术病理活检结果相比,诊断符合率为96.5％,误诊率为3.5％.数字乳腺钼靶摄影将3例乳腺癌误诊为乳腺纤维腺瘤,数字乳腺钼靶摄影与手术病理活检检查在乳腺病变的诊断方面无统计学差异.结论 数字乳腺钼靶可显示乳腺的一些细微结构和微小病灶,通过病变直径大小、结节形态、大导管征情况可区分乳腺的良、恶性病变.     

国产数字乳腺断层摄影在乳腺癌筛查中的初步研究

目的 初步探讨国产低剂量数字乳腺断层摄影(DBT)在女性体检乳腺癌筛查中的应用价值。方法 前瞻性搜集行乳腺DBT筛查患者的基本资料近600例,由两名高年资放射科医师观察其既往常规全数字化乳腺X线摄影(FFDM)图像和DBT及融合二维(SM)图像,记录图像分型、病灶分类及数据系统(BI-RADS)分类结果。结果 共纳入573例患者资料。DBT+SM图像与常规FFDM图像的BI-RADS分级诊断比较,差异无统计学意义(P>0.0125)。DBT+SM图像与常规FFDM图像的病灶筛查检出率比较,在肿块及结构扭曲方面,病灶检出率差异有统计学意义(P<0.0125),在钙化、腋窝淋巴结、非对称性改变、相关征象等方面,二者检出率差异无统计学意义(P>0.0125)。DBT+SM图像与常规FFDM图像对于肿块边缘及形态的检出差异无统计学意义(P>0.0125),对钙化形态的检出差异有统计学意义(P<0.0125)。结论 低剂量DBT+SM在女性乳腺癌筛查中对乳腺病变的总体诊断效能与常规FFDM相当,在显示肿块病变、结构扭曲、钙化形态及分布方面的效能优于常规FFDM,且辐...     

放大摄影在乳腺疾病诊断中的价值

目的 :评价放大摄影在乳腺良、恶性病变中的诊断价值。材料和方法 :对 115例临床扪及结节或肿块患者 ,行常规摄影和加摄局部放大摄影 ,于术后分别与病理对照 ,研究两种摄影方法对病灶的边界、形态、钙化等显示情况及诊断正确率。结果 :显示肿块边界 ,放大组 3 3 .9% ,常规组 14 .8% ;肿块边缘毛刺显示率 ,放大组 2 4.3 % ,常规组 13 .0 % ;对良性病变的诊断正确率 ,放大组 94.6% ,常规组 60 .8% ;对恶性病变诊断正确率 ,放大组 87.8% ,常规组 63 .4%。结论 :放大摄影可以明显提高乳腺疾病检出率和诊断正确性。     

乳腺MRI与乳腺X线摄影在乳腺疾病中的诊断价值分析

【摘要】目的：分析比较MRI与乳腺X线摄影在乳腺疾病中的诊断价值。方法：回顾性分析194例经手术及病理证实的乳腺病变患者的乳腺X线摄影及MRI资料,根据乳腺X线摄影上显示病灶的直接征象情况分为四组：有肿块并钙化组、有肿块无钙化组、无肿块有钙化组及无肿块无钙化组,分析比较两种检查方法在各组中的敏感度、特异度及诊断符合率的差异。结果：在194例病例中,MRI对乳腺病变的敏感度及诊断符合率均高于乳腺X线摄影（敏感度93.46% vs 78.50%,P=0.003,诊断符合率88.66% vs 78.35%,P=0.006）,特异度则与乳腺X线摄影接近（82.76% vs 78.16%,P=0.567）。在无肿块无钙化组中,MRI的敏感度和诊断符合率明显高于乳腺X线摄影（敏感度91.67% vs 8.22%,P=0.000,诊断符合率87.72% vs 71.93%,P=0.036）,特异度无明显差异（86.67% vs 88.89%,P=0.748）;而在其他三组中MRI和乳腺X线摄影的敏感度、特异度以及诊断符合率均无差异（P>0.05）。结论：MRI在乳腺X线摄影存在直接客观征象的乳腺病变中与乳腺X线摄影的诊断价值接近,但是在乳腺X线摄影未能发现直接客观征象的病例中具有较高的诊断价值。     

高频超声与全数字化乳腺摄影联合诊断乳腺导管癌的临床应用

目的:探讨乳腺导管癌的高频超声表现,并评价高频超声联合全数字化乳腺摄影检查对乳腺导管癌的诊断价值。方法:分析46例经病理证实的乳腺导管癌的超声表现,与相应病理结果进行对比分析。46例患者均行高频超声和全数字乳腺摄影检查。结果:高频超声探及到肿块46例,诊断乳腺癌45例,诊断率达98%。全数字化乳腺摄影诊断乳腺癌46例,诊断率达100%。高频超声和全数字化摄影对乳腺导管癌检出率无差别且无统计学意义(P>0.05)。结论:高频超声与全数字化乳腺摄影联合应用,可提高乳腺癌诊断的敏感性和准确性。     

乳腺X线摄影与乳腺计算机摄影技术的比较分析

目的：比较计算机摄影（CR）与屏／胶系统在乳腺摄片应用中的优缺点。方法：分别选取CR摄片和屏／胶摄片各100份，经三位有经验的中级以上医师和两名技师进行分析研究。结果：屏／胶摄片在空间分辨率和钙化点的发现率要优于CR摄片，但在对比度、清晰度、后处理方面CR摄片明显优于屏／胶摄片。结论：数字乳腺摄影值的提倡应用。     

彩色超声与乳腺X线摄影在乳腺癌筛查中的应用对比分析

目的探讨彩色B超与乳腺X线摄影在乳腺癌筛查中的临床应用价值。方法对收治的乳腺病患者应用彩色声与乳腺X线摄影进行检查,并就这两种检查方法在发现病变及良恶性肿块鉴别方面的诊断能力进行对比研究。结果彩色多普勒超声对乳腺癌患者恶性钙化灶的检出率75.00%,明显低于乳腺X线摄影85.94%,且差异具有统计学意义。但是彩色多普勒超声对乳腺癌患者的血流信号检出率84.38%明显高于乳腺X线摄影29.69%,且差异具有统计学意义。彩色超声和乳腺X线摄影诊断乳腺癌的符合率分别为89.06%、85.94%,经统计学分析发现两种筛查方法的符合率比较无明显差异。两种检查方法联合筛查符合率为96.88%,经统计学分析发现两者联合检查的符合率与两种方法的单独诊断符合率比较存在明显差异,且差异具有统计学意义。结论彩色多普勒超声和X线摄影早期筛查乳腺癌各有优势,相互补充,可提高乳腺癌诊断准确率。     

CR系统在乳腺钼靶摄影中的临床应用

目的：探讨计算机X线成像系统（CR系统）在乳腺钼靶X线摄影中的应用价值。方法：随机抽查屏／片乳腺片、CR钼靶乳腺图像各100份，比较两组照片的满意率、废片率、检出率和投照剂量。结果：普通钼靶摄影组的满意率、废片率、检出率分别为78％、2．8％和76％；数字化乳腺摄影组的满意率、废片率、检出率分别为99．7％、0和85％。CR系统仅用常规摄影剂量的1／5—1／10。结论：利用CR成像系统与钼靶摄影机的结合可以实现乳腺数字化摄影，效果优于普通屏／片摄影，在提高乳腺疾病的检出率方面更具优势，为临床早发现早治疗乳腺疾病提供了可靠依据。     

Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography

The goal of this prospective study was to compare a full-field digital mammography system (FFDM) to a conventional screen-film mammography system (SFM) for the detection and characterization of microcalcifications. Fifty-five patients with 57 isolated microcalcification clusters were examined using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, Wis.) and a SFM system (Senographe DMR, GE Medical Systems, Milwaukee, Wis.). A conventional screen-film mammogram and a digital contact mammogram were obtained of each cluster. The image quality and the number of calcification particles were evaluated, and a characterization (BI-RADS 1–5) of microcalcifications was given by four experienced readers. Histopathology revealed 16 benign lesions (sclerosing adenosis, dysplasia, hamartoma, radial scar) in 15 patients and 21 malignant tumors (in situ carcinoma, invasive carcinoma) in 20 patients. Twenty patients had benign changes verified by long-term follow-up. Image quality of FFDM was assessed as superior to SFM in more than 50% of the cases. The FFDM showed more calcifications in 41% of all cases. Sensitivity and specificity for FFDM vs SFM were 95.2 vs 91.9% and 41.4 vs 39.3%, respectively. Moreover, FFDM demonstrated a higher diagnostic accuracy (deviation: 0.86 BI-RADS steps) compared with FSM (deviation 0.93 BI-RADS steps). The FFDM system with a 100-μm pixel size provides better image quality than SFM in patients with mammographic microcalcifications. The FFDM has a higher sensitivity and a higher reliability in characterizing microcalcifications. Electronic Publication     

Comparison of screen-film and full-field digital mammography: image contrast and lesion characterization

PURPOSE: This study compared screen-film mammography (SFM) with full-field digital mammography (FFDM) of the same patients. MATERIALS AND METHODS: Twenty-four patients underwent surgery or biopsy, including 17 with carcinoma. Patients underwent both SFM and FFDM after providing informed consent. The abnormal findings consisted of 10 masses and 15 areas of microcalcification. The optical density of the breast tissue surrounding any lesion or mass was measured. Three readers evaluated the visibility of the masses and calcifications (contrast, margin, and type) by consensus from hard copies of the images. When evaluating FFDM, SFM was used as the standard of comparison. RESULTS: FFDM showed greater contrast of mass than SFM. The contrast of mass on FFDM was judged visually superior or equivalent to that of SFM, and microcalcifications were the same in most cases. The margin of the mass was better defined by FFDM in two cases. Determination of the type of microcalcification was similar for SFM and FFDM. CONCLUSION: FFDM provided greater contrast than SFM. FFDM might be helpful for detecting masses and observing their margins. Although FFDM may be of some use for detecting calcification, it has no advantage when determining the type of calcification.     

乳腺疾病的全数字化乳腺摄影与磁共振检查对比研究

目的:全数字化乳腺摄影与磁共振检查对乳腺疾病的诊断价值。材料和方法:本研究收集了自2003年12月至2006年1月期间行全数字化乳腺摄影并同时行磁共振检查患者共67例,全部经病理证实,其中良性病变38例,恶性病变29例。采用美国GE Senographe2000D全数字化乳腺摄影机及美国GE1.5Tesla MRI扫描仪;采用专门乳腺线圈。全部病例行动态增强扫描和图像后处理。结果:本组显示FFDM对乳腺疾病诊断的敏感性、特异性及准确性分别为74.29%,92.1%,83.36%;MRI对乳腺疾病诊断的敏感性、特异性及准确性分别为94.29%,89.47%,91.78%。结论:对于乳腺癌诊断FFDM的特异性高于MRI,而敏感性较低。     

Digital Breast Tomosynthesis Complements Two-Dimensional Synthetic Mammography for Secondary Examination of Breast Cancer

Objective:To compare the performance of two-dimensional synthetic mammography (SM) combined with digital breast tomosynthesis (DBT) (SM/DBT) and full-field digital mammography (FFDM) including women with DBT (FFDM/DBT) undergoing secondary examination for breast cancer.Material and Methods:Out of 186 breasts, including 52 with breast cancers; FFDM/DBT and SM/DBT findings were interpreted by four expert clinicians. Radiation doses of FFDM, SM/DBT, and FFDM/DBT were determined. Inter-rater reliabilities were analyzed between readers and between FFDM/DBT and SM/DBT by Cohen’s Kappa coefficients. Diagnostic accuracy was compared between SM/DBT and FFDM/DBT by Fisher’s exact tests. Two representative cancer cases were examined for differences in the interpretation between FFDM and SM.Results:A higher radiation dose was required in FFDM/DBT than in SM/DBT (median: 1.50 mGy vs. 2.95 mGy). Inter-rater reliabilities were similar between both readers and modalities. Both sensitivity and specificity were equivalent in FFDM/DBT and SM/DBT (p = 0.874–1.00). Compared with FFDM, SM did not clearly show abnormalities with subtle margins in the two representative cancer cases.Conclusion:SM/DBT had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation. DBT complements SM to improve accuracy to a level equivalent to that of FFDM. Taken together, SM/DBT may be a good substitute for FFDM/DBT for the secondary examination of breast cancer.     

Observer variability in screen-film mammography versus full-field digital mammography with soft-copy reading

Full-field digital mammography (FFDM) with soft-copy reading is more complex than screen-film mammography (SFM) with hard-copy reading. The aim of this study was to compare inter- and intraobserver variability in SFM versus FFDM of paired mammograms from a breast cancer screening program. Six radiologists interpreted mammograms of 232 cases obtained with both techniques, including 46 cancers, 88 benign lesions, and 98 normals. Image interpretation included BI-RADS categories. A case consisted of standard two-view mammograms of one breast. Images were scored in two sessions separated by 5 weeks. Observer variability was substantial for SFM as well as for FFDM, but overall there was no significant difference between the observer variability at SFM and FFDM. Mean kappa values were lower, indicating less agreement, for microcalcifications compared with masses. The lower observer agreement for microcalcifications, and especially the low intraobserver concordance between the two imaging techniques for three readers, was noticeable. The level of observer agreement might be an indicator of radiologist performance and could confound studies designed to separate diagnostic differences between the two imaging techniques. The results of our study confirm the need for proper training for radiologists starting FFDM with soft-copy reading in breast cancer screening. Presented at ECR, Wien 2006.     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

点压放大摄影对乳腺疾病的诊断价值

目的探讨点压放大摄影在乳腺肿瘤早期诊断中的价值。方法对仿真乳腺体模及30例乳腺有致密片团影的患者行常规摄片和点压放大摄片,对照研究了病灶的形状、边界、钙化、条索等显示情况。结果30例乳腺病灶的良、恶性诊断准确率近90％,明显高于常规平片对乳腺致密区检查的准确性。结论点压放大片有助于早期发现乳腺肿瘤,提高乳腺肿瘤的检出率和准确率。     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.     

Follow-up and final results of the Oslo I Study comparing screen-film mammography and full-field digital mammography with soft-copy reading

Purpose: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations.

Material and Methods: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations.

Results: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P = 0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P = 0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P = 0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value = 0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ).

Conclusion: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.