10 research outputs found
a cardiovascular magnetic resonance study
Background The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated
pig (hereafter, DOCA pig) was recently introduced as large animal model for
early-stage heart failure with preserved ejection fraction (HFpEF). The aim of
the present study was to evaluate cardiovascular magnetic resonance (CMR) of
DOCA pigs and weight-matched control pigs to characterize ventricular, atrial
and myocardial structure and function of this phenotype model. Methods Five
anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during
dobutamine stress. Left ventricular/atrial (LV/LA) function and myocardial
mass (LVMM), strains and torsion were evaluated from (tagged) cine imaging. 4D
phase-contrast measurements were used to assess blood flow and peak
velocities, including transmitral early-diastolic (E) and myocardial tissue
(E’) velocities and coronary sinus blood flow. Myocardial perfusion reserve
was estimated from stress-to-rest time-averaged coronary sinus flow. Global
native myocardial T1 times were derived from prototype modified Look-Locker
inversion-recovery (MOLLI) short-axis T1 maps. After in-vivo measurements,
transmural biopsies were collected for stereological evaluation including the
volume fractions of interstitium (VV(int/LV)) and collagen (VV(coll/LV)).
Rest, stress, and stress-to-rest differences of cardiac and myocardial
parameters in DOCA and control animals were compared by t-test. Results In
DOCA pigs LVMM (p < 0.001) and LV wall-thickness (end-systole/end-diastole, p
= 0.003/p = 0.007) were elevated. During stress, increase of LV ejection-
fraction and decrease of end-systolic volume accounted for normal
contractility reserves in DOCA and control pigs. Rest-to-stress differences of
cardiac index (p = 0.040) and end-diastolic volume (p = 0.042) were
documented. Maximal (p = 0.042) and minimal (p = 0.012) LA volumes in DOCA
pigs were elevated at rest; total LA ejection-fraction decreased during stress
(p = 0.006). E’ was lower in DOCA pigs, corresponding to higher E/E’ at rest
(p = 0.013) and stress (p = 0.026). Myocardial perfusion reserve was reduced
in DOCA pigs (p = 0.031). T1-times and VV(int/LV) did not differ between
groups, whereas VV(coll/LV) levels were higher in DOCA pigs (p = 0.044).
Conclusions LA enlargement, E’ and E/E’ were the markers that showed the most
pronounced differences between DOCA and control pigs at rest. Inadequate
increase of myocardial perfusion reserve during stress might represent a
metrics for early-stage HFpEF. Myocardial T1 mapping could not detect elevated
levels of myocardial collagen in this model. Trial registration The study was
approved by the local Bioethics Committee of Vienna, Austria
(BMWF-66.010/0091-II/3b/2013)
Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract
This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40–74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered.
Teaching Points
• US is an established tool for suspected cancers at all ages and also the method of choice under 40.
• For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings.
• High-risk women can be screened with US, especially when MRI cannot be performed.
• Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams.
• Breast US is inappropriate as a stand-alone screening method
Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.
UNLABELLED: EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. KEY POINTS: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future
Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract: We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as “high-risk” or B3 lesions). Finally, seven frequently asked questions are answered
Breast MRI : EUSOBI recommendations for women's information
This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADSA (R) categories and further actions after a breast MRI examination are discussed. Breast MRI is a very sensitive modality, significantly improving screening in high-risk women. It also has a role in clinical diagnosis, problem solving, and staging, impacting on patient management. However, it is not a perfect test, and occasionally breast cancers can be missed. Therefore, clinical and other imaging findings (from mammography/ultrasound) should also be considered. Conversely, MRI may detect lesions not visible on other imaging modalities turning out to be benign (false positives). These risks should be discussed with women before a breast MRI is requested/performed. Because breast MRI drawbacks depend upon the indication for the examination, basic information for the most important breast MRI indications is presented. Seventeen notes and five frequently asked questions formulated for use as direct communication to women are provided. The text was reviewed by Europa Donna-The European Breast Cancer Coalition to ensure that it can be easily understood by women undergoing MRI. aEuro cent Information on breast MRI concerns advantages/disadvantages and preparation to the examination aEuro cent Claustrophobia, implantable devices, allergic predisposition, and renal function should be checked aEuro cent Before menopause, scheduling on day 7-14 of the cycle is preferred aEuro cent During the examination, it is highly important that the patient keeps still aEuro cent Availability of prior examinations improves accuracy of breast MRI interpretation
Breast ultrasound : recommendations for information to women and referring physicians by the European Society of Breast Imaging
This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40-74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered. TEACHING POINTS: • US is an established tool for suspected cancers at all ages and also the method of choice under 40. • For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings. • High-risk women can be screened with US, especially when MRI cannot be performed. • Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams. • Breast US is inappropriate as a stand-alone screening method
Recommended from our members
Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract: We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as “high-risk” or B3 lesions). Finally, seven frequently asked questions are answered