Opportunities in cancer imaging: risk-adapted breast imaging in screening.

In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible

Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension

<p>Abstract</p> <p>A Gerbode -type defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis. This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. However, identification of an actual communication is often extremely difficult, so a careful and meticulous echocardiogram should be done in order to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension. The large systolic pressure gradient between the left ventricle and the right atrium would expectedly result in a high velocity systolic Doppler flow signal in right atrium and it can be sometimes mistakably diagnosed as tricuspid regurgitant jet simulating pulmonary arterial hypertension.</p> <p>We present a rare case of young woman, with endocarditis who presented with severe pulmonary arterial hypertension. The preoperative diagnosis of left ventricle to right atrial communication (acquired Gerbode defect) was suspected initially by echocardiogram and confirmed at the time of the surgery.</p> <p>A point of interest, apart from the diagnostic problem, was the explanation for its mechanism and presentation. The probability of a bacterial etiology of the defect is high in this case.</p

Introduction of an abbreviated breast MRI service in the UK as part of the BRAID trial: practicalities, challenges, and future directions.

Abstract Introduction Women with mammographically dense breasts have an increased risk of breast cancer. Dense breasts can limit detection of small breast lesions due to overlapping fibroglandular tissue. BRAID is a randomised, multi-centre UK study assessing the impact of supplementary imaging, including abbreviated breast MRI (ABB-MRI), in detection of breast cancer in women aged 50-70 years with dense breasts. ABB-MRI is a shorter protocol breast MRI, allowing much faster acquisition times. The aim of this study is to review the feasibility of introducing ABB-MRI into the NHS setting as a part of a research trial. Protocol ABB-MRI is performed on a 1.5 tesla MRI scanner. Sequences obtained include a 2 mm axial T2 weighted sequence, a dual echo (Dixon water/fat separation) 3D DCE acquisition consisting of one pre- and two post-contrast images with generation of post-contrast subtracted images and post-processed MIP images. Scheduling ABB-MRIs are performed on a dedicated breast MRI list. Participants arrive 30 minutes prior to appointment time with pre-filled safety questionnaire. ABB-MRIs are scheduled for a 20-minute appointment slot, allowing 10 women to be scanned in a 3-hour session. Specific roles are allocated to staff members. Improving Efficiency of ABB-MRI in the UK Challenges encountered are similar to those encountered with FDP: IV cannulation, BMI and claustrophobia. Dedicated MR sessions with standard contrast doses and prefilled safety questionnaires help improve efficiency of sessions and allow examination times under 15 minutes.GE Healthcare NIHR Senior Investigator Awar

Clinically Interpretable Radiomics-Based Prediction of Histopathologic Response to Neoadjuvant Chemotherapy in High-Grade Serous Ovarian Carcinoma

BackgroundPathological response to neoadjuvant treatment for patients with high-grade serous ovarian carcinoma (HGSOC) is assessed using the chemotherapy response score (CRS) for omental tumor deposits. The main limitation of CRS is that it requires surgical sampling after initial neoadjuvant chemotherapy (NACT) treatment. Earlier and non-invasive response predictors could improve patient stratification. We developed computed tomography (CT) radiomic measures to predict neoadjuvant response before NACT using CRS as a gold standard. MethodsOmental CT-based radiomics models, yielding a simplified fully interpretable radiomic signature, were developed using Elastic Net logistic regression and compared to predictions based on omental tumor volume alone. Models were developed on a single institution cohort of neoadjuvant-treated HGSOC (n = 61; 41% complete response to NCT) and tested on an external test cohort (n = 48; 21% complete response). ResultsThe performance of the comprehensive radiomics models and the fully interpretable radiomics model was significantly higher than volume-based predictions of response in both the discovery and external test sets when assessed using G-mean (geometric mean of sensitivity and specificity) and NPV, indicating high generalizability and reliability in identifying non-responders when using radiomics. The performance of a fully interpretable model was similar to that of comprehensive radiomics models. ConclusionsCT-based radiomics allows for predicting response to NACT in a timely manner and without the need for abdominal surgery. Adding pre-NACT radiomics to volumetry improved model performance for predictions of response to NACT in HGSOC and was robust to external testing. A radiomic signature based on five robust predictive features provides improved clinical interpretability and may thus facilitate clinical acceptance and application

Determination of changes in heavy metal accumulation depending on plant species, plant organism, and traffic density in some landscape plants

The level of pollution has reached the dimensions that threaten human health, with the rapid urbanization and the increase of energy consumption especially in developing countries. Every year in the world, millions of people lose their lives because of air pollution. Heavy metals have a separate precaution in pollutants, especially in terms of human health, because they can remain intact in nature for long periods of time, they tend to bioaccumulate and some are toxic or carcinogenic even at low concentrations. Therefore, monitoring of heavy metal pollution and determination of risky areas is very important. Biomonitors are the most commonly used methods for monitoring heavy metal pollution. However, determining which plants and organelles are more suitable for monitoring the metal is essential in order to ensure that the monitoring is reliable. In this study, it was aimed to determine the variations of the concentration of Ni, Pb, and Cd elements depending on the traffic density in leaves, seeds, and branches of Ailanthus altissima, Biota orientalis, Platanus orientalis, and Pyracantha coccinea which are grown in areas with heavy, low dense, and non-traffic areas. As a result of the study, it was determined that concentrations of Ni, Pb, and Cd increased depending on traffic density. According to the results obtained, it was determined that seeds and branches of Biota orientalis were the most suitable species and organelles to determine Ni pollution. The leaves of Ailanthus altissima are very suitable for monitoring the pollution of Pb and Cd. © 2018, Springer Nature B.V