钼靶X线对检出早期乳腺癌中广泛的导管内成分的作用

目的　评价钼靶X线对检出广泛的导管内成分 (EIC)的作用 ,为临床治疗提供参考。方法　经钼靶X线检查 ,手术、病理证实的Ⅰ、Ⅱ期乳腺癌 340例 348个病灶 ,包括浸润性导管癌2 97个、导管原位癌伴微浸润 8个、黏液腺癌 2 1个和髓样癌 2 2个。观察钼靶X线表现 ,与病理有无EIC对照。结果　 (1)浸润性乳腺癌EIC阳性较EIC阴性在钼靶X线片上显示钙化病灶的比例高(6 6 4 %、2 0 4 % ,χ2 =75 2 9,P <0 0 0 1)。尤其当表现为单纯钙化时 ,这种差别就更明显 (2 1 1%、2 0 % ,χ2 =5 2 5 6 ,P <0 0 0 1)。 (2 ) 5 4 6 % (10 7个 )的单纯肿块和 19 4 % (38个 )的临床扪及肿块而钼靶X线阴性的较易出现在浸润性乳腺癌EIC阴性中 ,与分别为 2 5 0 % (38个 )和 5 9% (9个 )出现在EIC阳性病例的比较差异有非常显著意义 (两者 χ2 值分别为 30 84和 13 2 9,P值均 <0 0 0 1)。(3)结构扭曲伴或不伴钙化对判断EIC差异无显著意义 (χ2 =1 84 ,P >0 0 5 )。 (4)阳性预测值统计显示 ,单纯钙化和钙化灶最大径≥ 3cm预示着浸润性乳腺癌有 88 9%和 95 8%的可能为EIC阳性 ,肿块伴钙化为 6 7 8%。相反 ,钼靶X线片上显示为钙化颗粒 <10枚或钼靶X线片为阴性 ,而临床扪及肿块时对EIC阴性的阳性预测值分别为 96 6 %和 80 9%     

MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component

PURPOSE: To determine the role of magnetic resonance (MR) mammography in detection and assessment of extent of tumors with extensive intraductal component (EIC+). MATERIAL AND METHODS: In a prospective study, 233 consecutive women with a suspicious lesion underwent preoperative MR mammography and 209 invasive ductal carcinomas were detected. We studied the prediction of intraductal spread on mammography (MX), ultrasound (US) and MR. We compared the size of the total lesion on MX, US and MR and correlated it with histopathology. Enhancement patterns on MR were described. RESULTS: Of 209 invasive ductal carcinomas, 50 were EIC+ (24%). MX predicted intraductal spread in EIC+ carcinomas in 48.5%, US in 34.2% and MR in 68%. Compared to MX and US, MR was best in assessment of total tumor size. On MR, ductal spread in EIC+ tumors presented as ductal or linear enhancement, long spicules, a regional enhancing area or nodules adjacent to a mass. CONCLUSION: MR had the highest sensitivity to predict intraductal spread and was superior in assessing total tumor size.     

Mammographic features predicting an extensive intraductal component in early-stage infiltrating ductal carcinoma.

Several studies have shown that the presence of an extensive intraductal component in patients with infiltrating ductal carcinoma is a major factor for predicting local recurrence after breast-conserving surgery and radiotherapy. A prospective study of 101 consecutive mammograms in patients with stage I or II infiltrating ductal carcinoma was performed to determine the predictive values of mammographic features in determining the presence or absence of an extensive intraductal component. Thirty-five (35%) of the lesions contained a pathologically verified extensive intraductal component. Sixty-five percent (22/34) of lesions showing mammographic evidence of calcifications with or without a mass were associated with an extensive intraductal component (p less than .001). Lesions with calcifications greater than 3 cm in extent were significantly (p less than .05) more likely to have an extensive intraductal component (9/10; 90%) than those with calcifications less than 3 cm in extent (13/24; 54%). Only 17% (8/46) of patients in whom mammograms showed only a mass or architectural distortion and 24% (5/21) of patients who had a mass palpable clinically or who had normal findings on mammograms had lesions with an extensive intraductal component. We conclude that infiltrating ductal carcinomas associated with calcifications on mammography, especially if the calcifications are extensive, are likely to be associated with an extensive intraductal component. Carcinomas without calcifications that show masses or architectural distortion on mammography, or carcinomas with palpable masses and normal findings on mammography, are unlikely to have an extensive intraductal component.     

Breast cancer with extensive intraductal component: treatment with immediate interstitial boost irradiation.

Extensive intraductal component (EIC) has been reported to have a prominent role in local recurrence after treatment of early-stage breast cancer with lumpectomy and irradiation. Pathologic specimens from 250 breasts (245 patients) treated between June 1982 and June 1990 with lumpectomy, immediate (boost) interstitial iridium-192 to 15-20 Gy, and external-beam irradiation to the entire breast to 45-50 Gy were reviewed. EIC was present in 61 breasts. At a median follow-up period of 58 months (range, 14-110 months), there were 10 recurrences in the 250 treated breasts. Of these 10, three were in patients from the group with EIC. The 10-year actuarial recurrence rates in breasts with and without EIC were 9.1% and 5.2%, respectively. The difference between the two rates was not significant. If an immediate boost with interstitial iridium is used in therapy, the influence of EIC on local failure is insignificant.     

Magnetic resonance imaging in the evaluation of lung cancer

MRI is used most efficaciously in the evaluation of patients with bronchogenic carcinoma when employed as a tailored examination designed to answer specific questions relevant to patient management. CT continues to be used more generally in staging lung cancer when imaging beyond conventional chest radiography is required. Specific areas in which MRI can provide important and unique information (which may supplement a CT study) include the following: (1) evaluation of the local extent of superior sulcus tumors, and (2) distinction between stage IIIA (resectable) and stage IIIB (unresectable) tumors. Confirmation of tumor invasion of major mediastinal structures is necessary before depriving a patient of potential curative resection. MRI may contribute important information when CT findings are indefinite, particularly with regard to invasion of major cardiovascular structures (eg, superior vena cava, pulmonary artery, pericardium, and heart); invasion of the tracheal carina or bilateral involvement of main bronchi; and the presence of contralateral mediastinal or hilar lymphadenopathy. MRI should be considered as a primary imaging modality to evaluate central tumors in patients for whom intravenous contrast agents are contraindicated, and as a problem-solving modality when CT is inconclusive in the detection of a possible hilar or mediastinal mass. Other specific applications of MRI include the identification of tumor recurrence in the presence of radiation fibrosis, assessment of the extent of chest wall invasion of peripheral lung tumors, and the noninvasive characterization of adrenal masses. The scope of these MRI applications in patients with lung cancer may expand in the future with refinements in motion suppression techniques, implementation of ultrafast MRI (using variations of the echoplanar method), and further development of MRI spectroscopy and MRI contrast agents.     

Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer

Objective

Breasts with malignant tumors can demonstrate a general increased vascularity compared to the contralateral breast and a prominent blood vessel adjacent to the tumor on magnetic resonance imaging (MRI). The aim of the study was to further characterize these alterations in blood supply by location of the tumor within the breast using MRI.

Materials and methods

The study group included 105 patients who underwent breast MRI for suspicion of a malignancy over a 2-year period. Fifty-one had pathologically verified malignant tumors (study group), 11 had pathologically verified benign lesions (control), and 43 had negative scans (control). The malignant lesions were distinguished by location, medial or lateral, within the breast. Origin of the vascular supply and vessel diameter was recorded in a blinded manner. When available, MRI scans performed 2 years after treatment were reviewed as well.

Results

Of the 24 medial malignant tumors, 21 (87%) had a predominantly medial vascular supply and 3 (13%), a predominantly lateral supply; of the 23 lateral tumors, 11 (48%) had a predominantly medial vascular supply and 8 (35%), a predominantly lateral supply (p = 0.03). In 4 cases, no dominant vessel was noted. Maximum vessel diameter was 3.6 ± 1.1 mm in the patients with malignancy and 2.6 ± 0.8 mm in the controls (p < 0.0005). General increased vascularity was demonstrated in 91% of the medial tumor subgroup and 83% of the lateral tumor subgroup, as opposed to 36-37% in the control groups (p < 0.0005). Follow-up MRI, performed in 8 patients in the malignant-tumor group after treatment, revealed a considerable decrease in the prominent vessels, to a size close to that of the controls.

Conclusion

Breasts with malignant tumors are characterized by an altered general vascular supply, a prominent feeding vessel, and increased regional vascularity. Both the presence and location of the tumor affect the vascular supply. The vascular change apparently diminishes after treatment, although this finding requires further investigation in a larger sample.     

Magnetic resonance imaging evaluation of residual ductal carcinoma in situ following preoperative chemotherapy in breast cancer patients

Objectives

To retrospectively evaluate the ability of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in helping to distinguish between lesions with and without residual ductal carcinoma in situ (DCIS) in patients showing no residual invasive cancer after preoperative chemotherapy.

Methods

DCE-MR images of 46 consecutive breast cancer patients (mean age, 47 years; range, 30–69 years) with no residual invasive cancer (15 had residual DCIS and 31 had no residual DCIS) following preoperative chemotherapy and surgery were blindly reviewed and categorized by two radiologists in consensus. Thereafter, DCE-MRI findings that could be helpful in distinguishing lesions with and without residual DCIS were analyzed.

Results

When any enhancement was present, 93% (14 of 15) sensitivity and 35% (11 of 31) specificity for the detection of residual DCIS on post-chemotherapy MRI were achieved. Although 65% (20 of 31) of lesions without residual cancer had some enhancing findings, the lesion to fibroglandular signal intensity ratio showed 86.7% (13 of 15) sensitivity and 83.9% (26 of 31) specificity with an Az value of 0.854 (95% confidence interval: 0.718, 0.940) when a cut-off point of a ratio of 1.34 was used.

Conclusion

DCE-MRI has the potential in distinguishing between lesions with and without residual DCIS in patients showing no invasive cancer after preoperative chemotherapy.     

Magnetic resonance imaging of the breast

This article reviews the current benefits and limitations of MR imaging of the breast. Techniques and results based on a review of the literature are first presented then analyzed. This imaging modality is clearly indicated for the diagnosis of recurrent disease and clinically occult breast cancers. Its value in other fields (neoadjuvant chemotherapy, staging of cancers, genetic cancers) is still experimental. Owing to its variable specificity, MRI is not currently recommended for the diagnosis of microcalcifications or evaluation of asymptomatic mammographically dense breasts. MR-guided interventional procedures should improve the value of this technique in breast pathology.     

Magnetic resonance imaging for axillary staging in patients with breast cancer

Purpose

To determine the utility of MRI for assessing axillary lymph node status in patients with breast cancer.

Materials and Methods

A consecutive series of patients who underwent breast MR before surgical management of breast cancer with axillary sampling between 2005 and 2007 were identified. MRs were evaluated for the number of nodes, contrast kinetics, nodal area, and number of nodes with no fatty hilum. Data were analyzed in the context of final breast pathology, sentinel lymph node status, and axillary nodal status. Correlations were analyzed using Kendall's τ‐b test. Reported P values are one‐sided.

Results

Fifty‐six females (median = 58 years) were studied. Sentinel lymph nodes (SLN) were positive in 15/56 patients (27%). All SLN + patients (n = 15) had completion axillary dissection. Extent of nodal disease was 1 (n = 3), 2 (n = 4), >2 (n = 8). Presence of any axillary lymph node with no fatty hilum and the number of nodes with no fatty hilum on MR significantly correlated with pathologic node positivity (P = 0.04); while kinetics, node number, and node size did not correlate.

Conclusion

Breast MR may be useful in the assessment of axillary nodes in patients with breast cancer. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.     

Magnetic resonance evaluation of the pericardium

Magnetic resonance (MR) is well suited to imaging the pericardium. High resolution images synchronized with the cardiac cycle can be obtained in any plane. The wide field of view allows additional anatomical and functional information to be obtained from adjacent structures such as the aorta, pleura, lungs and mediastinum. MR is particularly useful in cases of pericardial constriction without an associated effusion, in patients with complex or loculated pericardial effusions and in pericardial tumours. In this article we illustrate the characteristic MR features of a variety of pericardial pathologies.     

Magnetic resonance in the evaluation of intracranial aneurysms

Eighteen patients affected by intra-cranial aneurysms, with size ranging from 3 to 30 mm, were studied by means of MRI, CT, and angiography. MRI was performed using Spin-Echo (SE) sequences with different Repetition Times (TR) and Echo Times (TE), which allowed the characterization of the lesions in relation to the relaxation times. MRI could identify all the aneurysms. In 13 subjects the parent vessels could be seen. In 5 patients the aneurysms could be recognized only after angiography, due to their dimension (less than 4 mm). The "flow effects" and the presence of methemoglobin and hemosiderin in the thrombosed portion of the lumen allowed both the detection of flow abnormalities and the characterization of laminate intra-aneurysmal thrombosis. In conclusion, MRI appears to be a sensitive methodology in the detection of intracranial aneurysms, even more sensitive than CT and Angiography in characterizing this kind of lesions.     

Magnetic resonance in the evaluation of mediastinal masses

Thirty-three patients with mediastinal masses were examined by means of MRI to obtain elements for lesion characterization, to evaluate lesion extent, and to assess the relationship of the mass to the surrounding structures, especially the great vessels (accuracy: 84.84%), mediastinal structures (accuracy: 76.78%), and lung parenchyma (accuracy 69.69%). MR data were compared to CT findings; sensitivity, specificity and accuracy were subsequently compared to surgical and histologic findings. The results have shown MRI to be a very reliable method in the evaluation of mediastinal masses.     

Magnetic resonance imaging in the evaluation of pneumonia

Magnetic resonance imaging (MRI) of the lung is challenging because of substantial drawbacks. However, lung pathologies that are associated with increased attenuation values in CT enhance visualization in MRI: proton density is increased and tissue-air interfaces, resulting in susceptibility artifacts, are reduced in pneumonia, pneumonitis, edema, and carcinoma. On the other hand, many lung diseases result in shortness of breath, so that patients cannot hold their breath for long periods. Therefore, fast imaging techniques are required which should also allow for high spatial resolution so that small lesions can be detected. Calcifications and air pockets within lesions are not readily recognized with MRI. Thin section CT is standard for the diagnosis of pneumonia. With parallel imaging techniques, MRI examination of the lungs can be performed with short periods of breath holding, which allow for sub-centimeter resolution in the z-axis. Especially for follow-up examinations in immunocompromised patients and, in some instances, for the staging of malignant diseases (malignant pleural mesothelioma, lung cancer, respectively), MRI is very promising and may contribute to a decrease in the radiation exposure of the patients.