Mammography visual enhancement in CAD-based breast cancer diagnosis

This paper presents a novel approach to detect and discriminate abnormal and cueing signatures in mammography through enhancing the imaging contrast. Partial gland and adipose tissues are removed, and thus, the visual effect of mammography will be enhanced. Inspired by single image haze removal, we remove the majority of background tissues by introducing the idea of image matting. Experimental results show the feasibility and performance on distinguishing focuses from healthy tissues in the enhanced mammography. The method has potential applications on breast cancer diagnosis in computer-aided detection.     

Septate versus bicornuate uteri: errors in imaging diagnosis

Since two müllerian defects, the septate and bicornuate uteri, are no longer repaired by means of the same operative approach, an accurate preoperative diagnosis of these anomalies is now critical. A septum can be removed by means of hysteroscopic metroplasty. However, repair of a bicornuate uterus still requires abdominal surgery. Hysterosalpingography (HSG) has been the primary diagnostic modality for müllerian defects. On the basis of 63 patients, HSG findings alone, as interpreted by the radiologist, had a diagnostic accuracy of 55%. When this was supplemented with a gynecologic evaluation, the diagnostic accuracy improved to only 62.5%. However, when a diagnostic protocol that include ultrasound (US) examination with HSG was used for evaluating müllerian defects, the diagnostic accuracy improved to 90%, with all errors being noncritical. Therefore, it is concluded that HSG alone is not adequate to make the distinction between a septate and a bicornuate uterus unless the angle of divergence of two straight uterine cavities is 75 degrees or less, indicating a septate uterus. Luteal-phase US is frequently necessary to distinguish between these anomalies or to diagnose them in combination.     

乳腺不典型孤立小结节性病变的X 线定性诊断分析

目的：探讨<2 cm 的乳腺不典型孤立结节性病灶 X 线定性诊断要点。方法回顾性分析52例不典型小结节病灶的诊断及 X 线与临床特点。结果52例结节性病灶中,良性结节23例,恶性结节29例。其中被误诊为良性病变26例,X 线特点：结节形态规则,密度较均匀,边缘大部分光滑,可无分叶。被误诊为恶性病变19例,X 线特点：结节形态不规则,密度不均匀或伴多钙化灶,边缘或略分叶、毛糙、毛剌、周围结构不规则,或局部皮肤增厚,皮下脂肪浑浊。不能及时诊断7例,X 线特点：形态规则、不甚规则,密度不均匀、欠均匀,或周围结构欠规则,缺乏典型特征性表现。结论掌握各病变的病理 X 线特点及不典型表现,全面细致分析,结合超声及临床触诊,必要时 MRI、活检及随访多能作出正确诊断。     

Urography: problems and errors in the diagnosis of renal masses

New imaging modalities have gained a prominent role in both detection and diagnosis of kidney disorders. However, excretory urography (IVU) remains the screening examination of choice in everyday diagnostic routine, even though its value in characterising renal masses is poor. The search for more sensitive and less invasive diagnostic modalities has brought about some new dilemmas--e.g., which modality should be performed first when the clinical picture is suggestive of renal tumor, the presence of a malignancy with a negative IVU, small renal tumors as occasional findings--, and has enhanced previous problems,--e.g., technique, administration of i.v. contrast media. After defining the above problems, the authors discuss mistakes in the evaluation and interpretation of urograms. The problems are operator-dependent, or else they may be related to examination technique--e.g., inadequate preparation of the patient, poor image quality--, to the method of examination--e.g., inadequate injection of contrast agents (i.e., type, amount, method of injection)--, to kidney function and, finally, to lesion type. As for lesion type, errors can be related to the detection of the lesion itself--e.g., small renal masses (less than 3 cm phi)--and to lesion definition, due to atypical patterns or to difficult differentiation of tumors from normal findings, from anatomical variants or extrarenal structures.     

Echography: problems and errors in the diagnosis of renal masses

US plays an extremely important role in the diagnosis of renal masses. However, a number of diagnostic difficulties still exists in both identification of the mass and definition of its nature. The most frequent causes of diagnostic errors are discussed. Errors may be due to the radiologist, to technical limitations, and to the lesion itself. The radiologist is responsible for inexperience and negligence (incorrect application of the technique, limited clinical information, poor knowledge of US findings). Technical limitations are due to poor spatial and contrast resolution, to extremely fat patients, and to artifacts. As far as lesions are concerned, cystic and solid masses must be distinguished, since the problems are different. As for cystic lesions, problems are relative to their visualization and to the definition of their nature in cases of atypical or complex cysts, due to the complexity of some US findings. The latter involve both cystic wall and content and are related to calcifications, septa, vegetations, blood, purulent debris. In case of solid masses, problems concern the identification of small renal tumors, the differentiation among the various anatomical variants, the differential diagnosis of benign from malignant tumors, and the evaluation of tumor extent. The authors conclude that, whereas operator-dependent errors can be avoided, those inherent to technical parameters and to the lesion itself represent the diagnostic limitation of US.     

Mammography and color Doppler ultrasound in the diagnosis of breast cancer:a comparative study

目的:探讨乳腺癌X线摄影与彩色多普勒超声影像表现,提高X线摄影和超声对乳腺癌的诊断水平.方法:回顾性分析经病理证实的82位乳腺癌患者的病例资料.分析比较其X线摄影和超声的影像特征.结果:超声和X线摄影对病灶的检出率分别为100.00%、96.34%;对乳腺癌的诊断符合率分别为91.47%、89.02%,两者差异无统计学意义(P>0.05);两者联合对乳腺癌的诊断符合率为93.90%,与单纯超声和单纯X线摄影比较.差异均无统计学意义(P>0.05).结论:X线摄影和超声均能较准确检出并诊断乳腺癌,在乳腺癌临床诊断中起着重要作用.     

Contrast-Enhanced Spectral Mammography: Comparison with Conventional Mammography and Histopathology in 152 Women

Objective

The goal of the study was to compare conventional mammography (MG) and contrast-enhanced spectral mammography (CESM) in preoperative women.

Materials and Methods

The study was approved by the local Ethics Committee and all participants provided informed consent. The study included 152 consecutive patients with 173 breast lesions diagnosed on MG or CESM. All MG examinations and consults were conducted in one oncology centre. Non-ionic contrast agent, at a total dose of 1.5 mL/kg body weight, was injected intravenous. Subsequently, CESM exams were performed with a mammography device, allowing dual-energy acquisitions. The entire procedure was done within the oncology centre. Images from low and high energy exposures were processed together and the combination provided an "iodine" image which outlined contrast up-take in the breast.

Results

MG detected 157 lesions in 150 patients, including 92 infiltrating cancers, 12 non-infiltrating cancers, and 53 benign lesions. CESM detected 149 lesions in 128 patients, including 101 infiltrating cancers, 13 non-infiltrating cancers, and 35 benign lesions. CESM sensitivity was 100% (vs. 91% for MG), specificity was 41% (vs. 15% for MG), area under the receiver operating characteristic curve was 0.86 (vs. 0.67 for MG), and accuracy was 80% (vs. 65% for MG) for the diagnosis of breast cancer. Both MG and CESM overestimated lesion sizes compared to histopathology (p < 0.001).

Conclusion

CESM may provide higher sensitivity for breast cancer detection and greater diagnostic accuracy than conventional mammography.     

Computerized tomography: problems and errors in the diagnosis of renal masses

The diagnostic imaging of renal masses has greatly benefitted from US and CT. Nevertheless, a certain number of problems and errors are still present, and they must be discussed once more. In the authors' experience, problems and errors have 3 fundamental causes: operator, examination technique and complex patterns of renal masses. The latter is the most important cause of error in CT diagnosis. Complex patterns are seen in a limited number of cystic masses--i.e., hemorrhagic, inflammatory, and septated cysts, and cystic tumors. Hemorrhagic cysts, if hemorrhage is not recent, can cause some diagnostic difficulties since the typical high density of the recent hemorrhage is no longer present. Other renal masses may appear hyperdense on unenhanced CT scans, and therefore they must be considered in the differential diagnosis. Inflammatory cysts and abscesses are sometimes difficult to differentiate from other masses due to their aspecific appearance; clinical correlation is important in these instances to support CT diagnosis. Multiseptated cysts and cystic tumors cause huge problems of differential diagnosis. A good knowledge of differential CT findings is sure to reduce the problems in differentiating benign from malignant tumors and, among the latter, the different histotypes and metastases, when present as solitary masses. Also in this case, the correlation between CT, clinical history and other modalities can reduce the number of questionable cases.     

Screen-Film Mammography and Soft-Copy Full-Field Digital Mammography: Comparison in the Patients with Microcalcifications

Objective

We wanted to compare the ability of screen-film mammography (SFM) and soft-copy full-field digital mammography (s-FFDM) on two different monitors to detect and characterize microcalcifications.

Materials and Methods

The images of 40 patients with microcalcifications (three patients had malignant lesion and 37 patients had benign lesion), who underwent both SFM and FFDM at an interval of less than six months, were independently evaluated by three readers. Three reading sessions were undertaken for SFM and for FFDM on a mammography-dedicated review workstation (RWS, 2K×2.5K), and for FFDM on a high-resolution PACS monitor (1.7K×2.3K). The image quality, breast composition and the number and conspicuity of the microcalcifications were evaluated using a three-point rating method, and the mammographic assessment was classified into 4 categories (normal, benign, low concern and moderate to great concern).

Results

The image quality, the number and conspicuity of the microcalcifications by s-FFDM (on the RWS, PACS and both) were superior to those by SFM in 85.0%, 80.0% and 52.5% of the cases, respectively (p < 0.01), and those by the s-FFDM on the two different monitors were similar in 15.0%, 12.5% and 35.0% of the cases, respectively (p > 0.01). The mammographic assessment category for the microcalcifications in the three reading sessions was similar.

Conclusion

s-FFDM gives a superior image quality to SFM and it is better at evaluating microcalcifications. In addition, s-FFDM with the PACS monitor is comparable to s-FFDM with the RWS for evaluating microcalcifications.     

Mammography and echography in the diagnosis of expansive lesions in the dysplastic breast

The authors evaluated 177 cases of expansive lesions observed in diffusely dysplasic breast. The size of the lesions was less or equal to cm 2. They found that mammography had its diagnostic difficulties in benign lesions such as fibroadenomas and fibrocystic disease. Ultrasonography was carried out on 106 of those patients. The sensitivity of ultrasonography was the same for the definition of benign and malignant lesions. Moreover, it was not modified by the diffuse dysplasia.     

Digital Mammography: An Update

Mammography remains important for early detection and diagnosis of malignant breast diseases. In recent years, digital imaging technology has been able to address the challenges inherent in film-screen mammography and improve many aspects of care. Promising techniques include needle biopsies guided by digital mammography, computer-assisted diagnosis, tomosynthesis, contrast-enhanced mammography and scintimammography. Although it is unlikely that digital mammography will revolutionize how breast cancer is treated, it continues to enhance and help provide timely and accurate detection and diagnosis.