Integrated screening concept in women with genetic predisposition for breast cancer

Summary Breast cancer is in 5 % of cases due to a genetic disposition. BRCA1 and BRCA2 are by far the most common breast cancer susceptibility genes. For a woman with a genetic predisposition, the individual risk of developing breast cancer sometime in her life is between 70 and 90 %. Compared to the spontaneous forms of breast cancer, woman with a genetic predisposition often develop breast cancer at a much younger age. This is why conventional screening programs on the basis of mammography alone cannot be applied without modification to this high-risk group. In this article, an integrated screening concept for women with genetic predisposition for breast cancer using breast self-examination, clinical examination, ultrasound, mammography and magnetic resonance imaging is introduced.      

Breathhold MRI of the small bowel in Crohn's disease after enteroklysis with oral magnetic particles

Purpose: To evaluate the efficacy of breathhold MRI following enteroclysis with addition of oral magnetic particles to study the extension, detection of stenoses and extraluminal manifestations in Crohn's disease. Material and Methods: 18 patients with Crohn's disease and potential of surgical intervention were studied with enteroclysis with addition of oral magnetic particles. T1-/T2-weighted breathhold MRI w/o spectral fat suppression w/o i. v. Gd-DTPA was applied. Results: Typical findings were marked bowel wall thickening with strong contrast enhancement. 95.8 % of affected small bowel segments and 94.7 % of stenoses were correctly detected by MRI. All four fistulas were detected and important extraluminal findings were seen in 6/18 patients. Additionally, one ileoileal and two ileosigmoidal adhesions, two extraluminal abscesses and affection of the right ureter were delineated. Conclusion: MRI in Crohn's disease offers the potential to avoid radiation exposure in this relatively young patient group. Important additional findings relevant to indication of surgery are seen in approximately one third of cases. The replacement of transduodenal intubation by oral contrast application remains to be further studied.      

Silicone-selective multishot echo-planar imaging for rapid MRI survey of breast implants

The purpose of this study was to assess the usefulness of silicone-selective multishot echo-planar imaging (EPI) for the rapid magnetic resonance imaging (MRI) survey of breast implants. Twenty patients with bilateral breast implants underwent MRI. The use of inversion recovery and magnetization transfer pulses led to silicone-selective images. The rapid MRI survey required only 43 s, which accurately distinguished between silicone and non-silicone materials in the implants, and therefore induced the final MRI sequences appropriate for the detailed characterization of the implants. In 5 of the 20 patients, the rapid MRI survey showed implanted materials that were not indicated from clinical information. This silicone-selective multishot EPI allows a rapid survey of breast implants, which is useful to avoid unnecessary sequences in these patients.     

乳腺癌新辅助化疗的动态增强磁共振成像评价

目的:探讨乳腺癌患者新辅助化疗(NAC)后通过动态增强MRI评估肿瘤边界的准确性;观察NAC前、后时间-信号强度曲线(TIC)变化。方法:搜集57例行NAC乳腺癌患者,化疗前后均行病理及MRI检查,以病理结果作为金标准,将NAC后MRI所测肿瘤最大径与其进行比较;观察记录NAC前、后TIC类型。结果:化疗后MRI测量的肿瘤最大径与病理量出的最大径有很高的相关性(r=0.926,P<0.005);NAC后TIC类型变化多样。结论:动态增强MRI可以对乳腺癌NAC后进行有效评价。化疗前、后的TIC变化可以为临床评价NAC疗效提供丰富的信息。     

3T磁共振高分辨动态增强诊断小乳癌的应用研究

目的:探讨磁共振高分辨动态增强检查对小乳腺癌诊断的临床应用价值。方法:回顾性分析病理证实的20例(21个病灶)小乳腺癌(最大径≤2cm)的MRI高分辨动态增强检查的形态学及血流动力学特征。结果:小乳腺癌的特征性表现为形态不规则或分叶、边缘不规则或者毛刺、不均匀环形强化的肿块样病变以及局灶、不均匀或簇集样强化的非肿块病变,时间-信号强度曲线:平台型7例(33.3%),流出型14例(66.7%)。对侧对称部位正常乳腺为逐渐轻度强化,时间-信号强度曲线均为持续型。结果显示小乳腺癌灶与正常乳腺组织之间的血流动力学变化有显著差异。结论:3T磁共振高分辨动态增强检查能够提供清晰、丰富的形态学及血流动力学信息,对小乳腺癌的诊断和鉴别诊断具有重要价值。     

Role of diffusion-weighted imaging as an adjunct to contrast-enhanced breast MRI in evaluating residual breast cancer following neoadjuvant chemotherapy

Objective

To investigate whether the addition of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced MRI (DCE-MRI) improves diagnostic performance in predicting pathologic response and residual breast cancer size following neoadjuvant chemotherapy.

Materials and methods

A total of 78 consecutive patients who underwent preoperative breast MRI with DWI following neoadjuvant chemotherapy were enrolled. DWI was performed on a 1.5 T system with b values of 0 and 750 s/mm. or on a 3 T system with b values of 0 and 800 or 0 and 1000 s/mm. The images on DCE-MRI alone, DWI alone, and DCE-MRI plus DWI were retrospectively reviewed. We evaluated the diagnostic performances of the three MRI protocols for the detection of residual cancer. The tumor size as predicted by MRI was compared with histopathologic findings. Apparent diffusion coefficient (ADC) values were also compared between the groups with and without residual cancer.

Results

Of the 78 patients, 59 (75.6%) had residual cancer. For detection of residual cancer, DCE-MRI plus DWI had higher specificity (80.0%), accuracy (91.0%), and PPV (93.2%) than DCE-MRI or DWI alone (P = 0.004, P = 0.007, and P = 0.034, respectively). The ICC values for residual cancer size between MRI and histopathology were 0.891 for DCE-MRI plus DWI, 0.792 for DCE-MRI, and 0.773 for DWI. ADC values showed no significant differences between residual cancer and chemotherapeutic changes (P = 0.130).

Conclusions

The addition of DWI to DCE-MRI significantly improved diagnostic performance in predicting pathologic response and residual breast cancer size after neoadjuvant chemotherapy.     

Perfusion MRI in cerebral infarction

Purpose: To investigate the hemodynamic changes in patients with acute cerebral stroke by perfusion MRI. Materials and methods: In 12 patients with acute stroke in the territory of the middle cerebral artery, perfusion MRI was performed. Peak time, mean transit time, regional cerebral blood volume and regional cerebral blood flow were calculated in the infarction, the peri-infarction area and the contralateral hemisphere. Results: In the infarction the mean blood flow was 29 ml/100 g/min, compared to about 40 ml/100 g/min in the peri-infarction area and the contralateral hemisphere. In two patients increased cortical blood flow was found in the infarction due to luxury perfusion. The cerebral blood volume was reduced in the infarction, but significantly increased, to 7.3 ml/100 g, in the peri-infarction tissue. Conclusion: Perfusion MRI allows one to differentiate various patterns of perfusion disorders in patients with acute cerebral stroke. The resulting data may be helpful in describing the pathophysiologic mechanisms of compensation.      

Clustered microcalcification following breast implant removal mimicking malignancy

On mammography, clustered microcalcification can be an early and sensitive sign of malignancy, although it is also commonly seen in benign alterations of the breast. We report on a 52-year-old woman with mammographically suspicious granular calcification as a late result of a short-term silicone augmentation. Plain film, surgical, and histopathological features are demonstrated. Received: 13 July 2000 Revised: 5 October 2000 Accepted: 5 October 2000     

DCE-MRI减影技术及DWI序列在原发性肝癌局部介入术后评估的应用研究

目的探讨磁共振动态增强减影技术及DWI序列在原发性肝癌经局部介入治疗术后疗效评估中的应用价值。方法收集56例经临床或病理证实为原发性肝癌的患者,同时满足1)接受过射频消融、微波消融、动脉内碘油栓塞等局部介入治疗术后≥6个月;2)治疗后病灶MRI表现为平扫T1高信号,且病灶直径≥1cm。共纳入符合标准的74个病灶,根据mRECIST标准,将所有病灶分为完全坏死组(42个病灶)和复发残留组(32个病灶)。由两位腹部影像诊断医师对MRI常规动态增强、动态增强减影及DWI(联合ADC)图像分别进行肉眼分析并对疗效判断的信心度进行评分,采用方差分析比较三种技术医师信心度水平差异;分别计算病灶在MRI常规动态增强与增强减影后动脉期、静脉期图像上的对比信噪比(CNR),采用t检验比较减影前后差异;测量所有病灶ADC值并对比完全坏死组与复发残留组之间差异。P<0.05为差异有统计学意义。结果完全坏死组1)诊断医师对常规动态增强、动态增强减影、DWI(联合ADC)三种技术肉眼判断肿瘤完全性坏死的信心度评分无显著差异;2)MRI动态增强动脉期减影前、后病灶CNR值无显著差异;静脉期减影后病灶CNR值明显大于减影前。复发残留组1)三种技术判断病灶内仍有活性肿瘤组织残留或复发的医师信心度评分由高到低为动态增强减影>常规动态增强>DWI(联合ADC);2)MRI动态增强动脉期、静脉期减影后病灶CNR值均显著大于减影前。复发残留组病灶平均ADC值明显低于完全性坏死组。结论与常规动态增强相比,减影技术结合DWI及ADC图像的定量分析,可以更加准确评估原发性肝癌局部治疗疗效。     

动态增强MRI检查分级评估良恶性乳腺团块型病灶的价值

目的 探讨鉴别乳腺良恶性病灶的客观评分方法,为乳腺团块型病灶的良恶性判断提供客观评价依据.方法 将第4版乳腺影像和报告系统(BI-RADS)的MR部分对团块型病灶的描述作为病灶评价指标对188个高血供团块型病灶评分,根据评分结果与病理结果进行ROC曲线分析,计算曲线下面积并计算最佳良恶性诊断阈值;根据最佳诊断阈值及病灶良恶性倾向将病灶归入Ⅰ～Ⅴ级(Ⅰ级阴性、Ⅱ级良性、Ⅲ级可能良性、Ⅳ级可疑恶性、Ⅴ级高度提示恶性),最后检测评分方法诊断恶性团块型病灶的敏感度和特异度.结果 病理证实188个高血供病灶中有91个恶性,97个良性.ROC曲线下面积为0.938±0.016,评分法鉴别病灶良恶性的最佳阈值为5分.病灶分级结果为Ⅱ级24例、Ⅲ级72例、Ⅳ级54例、Ⅴ级38例.评分法诊断恶性乳腺团块型病灶的敏感度为87.91％,特异度为87.62％.除去Ⅲ级中3例假阴性的导管原位癌,特异度提高到90.90％.结论 建立在多参数标准化分析基础上的评分方法有助于客观判读乳腺动态增强MR影像.     

Value of contrast-enhanced 3D MR angiography of the renal arteries

Summary Purpose: To determine the value of gadolinium-enhanced, three-dimensional breathhold Magnetic Resonance Angiography (MRA) in the assessment of the aorta and renal arteries in comparison to conventional arteriography (CA). Patients and methods: 49 patients were evaluated with both CA and 3D MRA. 0.3 mmol/kg BW gadolinium-DTPA was administered intravenously in a bolus, using an automated injector. A test bolus method was used for timing of the bolus and beginning of the data acquisition. The intraarterial CA was used as the gold standard. Results: MRA-based assessment of renal artery stenosis was identical with CA in 31 of 45 stenoses (68.8 %). Sensitivity and specificity for assessment of renal arterial disease by MRA were 84 % and 96 %; for clinically relevant lesions they amounted to 90 % and 98 %. Conclusion: The presented contrast-enhanced 3D MRA technique allows for the reliable assessment of renal arterial morphology and pathology.      

CT and MRI of the middle ear

Summary High-resolution computed tomography (HRCT) provides excellent contrast between osseous structures, air and soft tissue in conjunction with high spatial resolution. Therefore, thin-section HRCT with bone window setting is the method of choice for the examination of the middle ear structures. The indications are acute and chronic inflammatory changes, cholesteatoma and tumor, the “postoperative middle ear”, and malformations. In most cases, HRCT enables differentiation between inflammatory changes, cholesteatoma, and tumor. The excellent depiction of subtle osseous details enables the identification of erosions of the ossicles or of the bony walls of the mastoid cells, of osseous defects of the tegmen, of the bony labyrinth, and of the tympanic course of the facial canal. In addition, HRCT enables excellent depiction of reconstructions of the ossicles or prosthesis of the ossicles. Although HRCT is the first method of choice, magnetic resonance imaging (MRI) may provide additional information and lead to a more accurate diagnosis in some cases. This is explained by the excellent soft tissue contrast provided by MRI. In addition, MRI offers the possibility of using various pulse sequences and the administration of IV contrast material. Therefore, MRI may allow the differentiation between inflammatory changes, cholesteatoma, and tumor in those cases in which accurate diagnosis cannot be made by HRCT. The differentiation between a meningocele or meningoencephalocele and other entities such as tumors or cholesteatoma can be established by MRI. Furthermore, MRI can accurately depict cases of labyrinthitis or of neuritis of the facial nerve or of intracranial disease caused by middle ear processes, while this is not always possible by HRCT. In summary, HRCT of the middle ear is the method of choice, but MRI may provide supplementary information in those cases in which accurate diagnosis cannot be established by HRCT.      

乳腺癌患者新辅助化疗的MRI研究

乳腺癌新辅助化疗(亦称初始化疗或术前化疗)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的。随着新辅助化疗在乳腺癌患者中不断推广应用,临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法,本文对RI(magnetic resonance imaging)在乳腺癌新辅助化疗中的研究进行综述。     

乳腺癌MRI表现与免疫组化相关性的初步研究

目的:探讨乳腺癌的ER、PR、CerbB-2、VEGF表达与MRI征象之间的关联性。方法:对50个乳腺癌患者术前行乳腺MR扫描,分析乳腺癌的MRI影像学表现,术后标本行免疫组织化学染色测定肿瘤细胞ER、PR、CerbB-2、VEGF表达情况,并分析与相应病灶MRI表现的关系。结果:乳腺癌的MRI多表现为形态不规则、分叶状或类圆形结节,边缘毛刺,边界模糊,部分病灶内部见坏死;大部病灶在T1WI呈略低信号,在脂肪抑制T2WI呈不均匀高信号;Gd-DTPA增强扫描后,呈明显均匀或不均匀强化、斑驳样强化或边缘环形强化。乳腺癌病灶早期边缘强化与癌细胞VEGF阳性表达呈显著正相关(r=0.873;P0.01);毛刺状边缘与ER、PR、VEGF阳性表达呈正相关(r=0.702,0.764,0.497;P0.05);内部坏死与CerbB-2阳性表达呈显著正相关(r=0.718;P0.01);形态与癌细胞ER、PR、CerbB-2、VEGF表达情况无显著相关性(r=0.129,0.312,0.343,0.254;P0.05)。结论:乳腺癌MRI征象与免疫组化标记物之间存在一定的相关性,对我们从影像角度评估乳腺癌的生物学行为和预后有一定的参考价值。     

MRI诊断扪诊阴性的乳腺占位性疾病

目的：评价ＭＲＩ诊断扪诊阴性的乳腺疾病的敏感性、特异性并探讨其临床意义。材料与方法：应用ＭＲ快速小角度激发三维成像（ＦＬＡＳＨ－３Ｄ）对２６例Ｂ超或Ｘ线检查提示或怀疑有占位，而临床检查未扪及肿块病人的乳腺进行常规及动态检查。结果：发现孤立性病灶２１个，根据病灶形态、边缘、信号均匀度及增强前后信号的动态变化确定典型癌性病变４例，典型良性病变１１例，非典型病变１１例。经病理学对照，本组病例ＭＲＩ的敏感性为１００％，特异性６５％。结论：对于典型良、恶性病变，ＭＲＩ的特异性较高，尽管对非典型良、恶性病变重叠较大，但ＭＲＩ为这类病变提供了细胞学检查和预防性手术的影像学依据。     

乳腺疾病的MRI诊断

目的：探讨乳腺疾病的MRI平扫与增强扫描的影像特点。方法：收集乳腺疾病33例，其中乳腺癌12例，良性病变18例，隆乳术后患者3例，均行MRI扫描，22例同时进行钼靶摄影。结果：①乳腺癌MRI表现为：形态不规则结节或肿块，边缘分叶或毛刺，增强扫描多呈不均匀强化，毛刺样结构显示更清晰。②良性病变：纤维腺瘤病灶呈圆形或类圆形，边缘光滑，无毛刺样结构，增强后均匀强化；乳腺增生表现为乳腺腺体增厚，形态规则。③MRI与钼靶结果比较，MRI在发现病灶，了解病变范围以及显示淋巴结转移方面优于钼靶。结论：MRI是评价乳腺疾病的一种有效的影像学方法。     

Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer

We compared dynamic contrast-enhanced MRI (DCE-MRI) and sonography (US) for monitoring tumour size in 21 patients with breast cancer undergoing primary chemotherapy (PCT) followed by surgery. The correlation between DCE-MRI and US measurements of tumour size, defined as the product of the two major diameters, was 0.555 (P=0.009), 0.782 (P<0.001), and 0.793 (P<0.001) at baseline, and after two and four cycles of PCT, respectively. The median tumour size was significantly larger when measured by DCE-MRI than by US at baseline (1472 vs 900 mm², P<0.001) and after two cycles of PCT (600 vs 400 mm², P=0.009). After PCT, the median tumour size measured by the two techniques was similar (256 vs 289 mm² for DCE-MRI and US, respectively, P=0.859). The correlation with the histopathological major tumour diameter was 0.824 (P<0.001) and 0.705 (P<0.001) for post-treatment DCE-MRI and US, respectively. Measurements of the final major tumour diameter by DCE-MRI tended to be more precise, including cases achieving a pathological complete response. Randomized trials are warranted to establish the clinical impact of the initial discrepancy in tumour size estimates between DCE-MRI and US, and the trend towards a better definition of the final tumour size provided by DCE-MRI in this clinical setting.This work was accepted as a scientific presentation at the ECR 2004 meeting.     

乳腺疾病的MRI研究进展

MRI具有极佳的软组织分辨率,近年来,该技术越来越广泛的应用于乳腺疾病的诊断.乳腺动态增强成像和灌注加权成像可从不同角度反映乳腺组织及病灶的血供灌注情况,弥散加权成像和磁共振波谱分析则从分子水平提供乳腺病变组织信息,磁共振乳腺导管成像为导管内病变提供了新的影像诊断方法.随着MRI技术的成熟、软硬件的迅速发展,MRI在乳腺疾病的检出和诊断方面显示出其独到的优势.     

Performance of preoperative breast MRI based on breast cancer molecular subtype

PurposeTo assess the performance of preoperative breast MRI biopsy recommendations based on breast cancer molecular subtype.MethodsAll preoperative breast MRIs at a single academic medical center from May 2010 to March 2014 were identified. Reports were reviewed for biopsy recommendations. All pathology reports were reviewed to determine biopsy recommendation outcomes. Molecular subtypes were defined as Luminal A (ER/PR+ and HER2-), Luminal B (ER/PR+ and HER2+), HER2 (ER-, PR- and HER2+), and Basal (ER-, PR-, and HER2-). Logistic regression assessed the probability of true positive versus false positive biopsy and mastectomy versus lumpectomy.ResultsThere were 383 patients included with a molecular subtype distribution of 253 Luminal A, 44 Luminal B, 20 HER2, and 66 Basal. Two hundred and thirteen (56%) patients and 319 sites were recommended for biopsy. Molecular subtype did not influence the recommendation for biopsy (p = 0.69) or the number of biopsy site recommendations (p = 0.30). The positive predictive value for a biopsy recommendation was 42% overall and 46% for Luminal A, 43% for Luminal B, 36% for HER2, and 29% for Basal subtype cancers. The multivariate logistic regression model showed no difference in true positive biopsy rate based on molecular subtype (p = 0.78). Fifty-one percent of patients underwent mastectomy and the multivariate model demonstrated that only a true positive biopsy (odds ratio: 5.3) was associated with higher mastectomy rates.ConclusionBreast cancer molecular subtype did not influence biopsy recommendations, positive predictive values, or surgical approaches. Only true positive biopsies increased the mastectomy rate.     

MRI of the fingers in patients with systemic scleroderma. Early results of contrast-enhanced examinations on a dedicated MRI system

Purpose. To estimate disease activity in patients with systemic sclerosis using contrast-enhanced MRI of the skin. Material and Methods. In a pre-study, sequences of a low-field (0.2 T) scanner (Artoscan, Esaote, Genova, Italy) were optimized for detection of intravenous contrast (0.1 mmol/l Gd-DTPA) in six patients with the autoimmune disease systemic scleroderma. Based on the results of the pre-study, 17 patients with scleroderma (7 sclerotic/10 active inflammatory disease) were scanned using gradient-spoiled 3D GRE sequences (FA 90 °, TR 100 ms, TE 18 ms), which had been established as most sensitive for intravenous contrast. Contrast enhancement of the skin was determined quantitatively by contrast-to-noise ratios (CNR), comparing post- to pre-contrast and dynamic scans (for 6 min, 1 acquisition/min). Patients in the chronic state with sclerodactylia and active inflammation of the hands were considered separately and compared to a control group (n = 10) matched according to age. Results. CNR increase after intravenous contrast was significantly higher in patients with active disease (86 ± 16 % increase) than sclerosing disease (29 ± 3 %, p < 0.05) and the control group (4 ± 2 %, p < 0.05). The dynamic examination showed a significantly slower decrease after the peak rise in the first minute in patients with active disease (CNR 15.4 ± 0.7 to 14.2 ± 1.4) than in those with chronic disease (14.1 ± 0.5 to 11.3 ± 0.9, p < 0.05). Discussion. Capillary leakage is the most likely explanation for the increased enhancement in patients with active scleroderma. Using sequences optimized for contrast detection, disease activity in the course of scleroderma and response to therapy can be determined by MRI in the future.