Efficacy of Mammographic Evaluation of Breast Cancer in Women Less Than 40 Years of Age: Experience from a Single Medical Center in Taiwan

Background/PurposeMammography is the standard imaging modality for breast cancer diagnosis. However, the value of mammographic diagnosis in breast cancer patients aged less than 40 years old has not been well assessed. The goal of our study was to determine the diagnostic efficacy of mammography for the detection of breast cancer in women under 40 years of age in a single medical center in Taiwan.MethodsOf 1766 women diagnosed with breast cancer in one medical center between 1999 and 2005, 227 (12.9%) who were younger than 40 years of age were enrolled, and 105 of these 227 patients had pre-biopsy mammograms available for analysis. The sensitivities for mammography at first (prospective) and second (retrospective) readings and for corresponding ultrasound were calculated. The distribution of different breast composition between the mammographic true-positive (TP) and false-negative (FN) lesions at the first and second readings was analyzed.ResultsOf the 105 patients, 104 presented with a palpable mass and the other one was asymptomatic. There were 109 pathologically proven breast cancers from the 105 patients; 92 of 109 cancerous lesions were detected at the first mammographic reading (sensitivity 84.4%), and the most common mammographic sign was microcalcifications (40.2%). The second reading detected seven additional cancers (99 of 109 lesions; sensitivity 90.8%). There was no significant difference between mammographic TP and FN lesions for the different breast composition on first and second readings. Ninety patients also had ultrasound available for correlation with 94 cancers diagnosed from them. The diagnostic sensitivity of ultrasound was 94.7% (89 of 94 lesions).ConclusionMammography has an acceptable sensitivity for the detection of breast cancer in women aged less than 40 years, regardless of different breast composition. Breast ultrasound can offer a higher sensitivity for such a population

Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study

<p>Abstract</p> <p>Background</p> <p>The study was conducted to investigate the diagnostic performance of infrared (IR) imaging of the breast using an interpretive model derived from a scoring system.</p> <p>Methods</p> <p>The study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8) with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring system that combines five IR signs. The ROC (receiver operating characteristic) curve and AUC (area under the ROC curve) were analyzed by the univariate logistic regression model for each IR sign and an age-adjusted multivariate logistic regression model including 5 IR signs. The cut-off values and corresponding sensitivity, specificity, Youden's Index (Index = sensitivity+specificity-1), positive predictive value (PPV), negative predictive value (NPV) were estimated from the age-adjusted multivariate model. The most optimal cut-off value was determined by the one with highest Youden's Index.</p> <p>Results</p> <p>For the univariate model, the AUC of the ROC curve from five IR signs ranged from 0.557 to 0.701, and the AUC of the ROC from the age-adjusted multivariate model was 0.828. From the ROC derived from the multivariate model, the sensitivity of the most optimal cut-off value would be 72.4% with the corresponding specificity 76.6% (Youden's Index = 0.49), PPV 81.3% and NPV 66.4%.</p> <p>Conclusions</p> <p>We established an interpretive age-adjusted multivariate model for IR imaging of the breast. The cut-off values and the corresponding sensitivity and specificity can be inferred from the model in a subpopulation for diagnostic purpose.</p> <p>Trial Registration</p> <p>NCT00166998.</p

Angiogenesis in hematological malignancy – Evaluated by dynamic contrast-enhanced MRI

Bone marrow angiogenesis can be measured by DCE-MRI. DCE-MRI is an imaging technique that appears to provide quantitative and biologically relevant information related to tumor vasculature and angiogenesis, which can inform novel drug efficacy, monitor treatment response and act as an imaging biomarker to predict treatment outcome and survival in hematological malignant patients. Increased bone marrow perfusion as reflected by higher Peak value can independently predict adverse clinical outcome in patients with acute myeloid leukemia (AML). In addition, DCE-MRI derived data of bone marrow in AML patients at remission status provides useful information on clinical outcome of patients who might have relapse or not. Patients with a higher value for Kep at remission status would have shorter relapse-free duration and may need to undergo additional therapy. In multiple myeloma, DCE-MRI data correlate strongly with marrow tissue microvessel density. Studies identify high Amplitude values as a possible risk factor associated with the development of extra-medullary disease in multiple myeloma patients; these findings partly support the hypothesis that bone marrow angiogenesis may play role in the development of extra-medullary disease in multiple myeloma. DCE-MRI derived-parameters could serve as a guidance for the selection of optimal management plans, thereby contributing to the development of “personalized medicine” for patient

Early Diagnosis of Single Segment Vertebral Osteomyelitis-Mr Pattern and Its Characteristics

Nine cases of single segment vertebral osteomyelitis were included based on the single level of vertebral body involvement according to the MR findings. They were 3 cases with tuberculous infection and 6 cases with pyogneic infection. The vertebral body involvement was presented as abnormal signal changes (100%) and heterogenous enhancement( 77.7%). They usually caused the cortical disruption in its anterior aspect (100%). It goes along the up-ward subligamentous spred (55.5%). The lower disc involvement is least common (11.1%). By using these criteria, the single segment vertebral osteomyelitis could be earlier diagnosed

以動態顯影磁振掃描來預測肝細胞癌對抗血管新生治療的反應

大部分晚期肝細胞癌的病人只能接受全身性的治療。因為肝細胞癌是一個高血流的腫 瘤，新的治療藥物多半著重在抑制腫瘤的血管新生。動態顯影磁振造影的技術，可以 用來量測微血流環境與腫瘤的血管新生，有效的治療會改變動態顯影磁振造影的量化 參數，進而正確並早期顯示腫瘤對抗血管新生的藥物反應。雖然動態顯影磁振造影已 被廣泛運用於評估各種腫瘤的血管新生以及新藥的療效，但是在肝細胞癌病人的相關 研究還很少。大的肝細胞癌的組成相當不均勻，內部的微血流環境變化很大。動態顯 影磁振造影併用藥物動力模型能夠將肝細胞癌所量測的量化參數轉換為具有高度可重 複性的彩色圖形。利用這樣的圖形，我們可以圈選整個腫瘤或是腫瘤內高血流的部份 來得到一個平均值，並比較治療前後這些數值的改變。我們初步的經驗顯示Ktrans 平均值的降低能夠預測晚期肝細胞癌病人接受治療後將會達到穩定或是惡化的狀態。 但是對於動態顯影磁振造影是否真正具有預測抗血管新生藥物療效的價值，需要更多 的研究與資料來佐證。 The majority of patients with advanced hepatocellular carcinoma (HCC) are only eligible to systemic therapies. As HCC is a hypervascular tumor, many emerging therapies act on the inhibition of angiogenesis. Dynamic contrast-enhanced MR imaging (DCE-MRI) can be used to measure microcirculation and tumor angiogenesis. Successful therapies change quantitative parameters on DCE-MRI, which may prove to be accurate and early indicators of tumor re- sponse to anti- angiogenesis agents. Although DCE-MRI is widely applied in assessing tumor response in various tumors, only few studies demonstrate its predictive value in patients with HCC. Large HCC is biologically heterogeneous, exhibiting variation in microvasculature. DCE-MRI combined with a pharmacokinetic model allows us to produce highly reproducible parametric maps of quantitative parameters in HCC. By using pixel-by-pixel mapping, mean values of these parameters of pixels within region of interest (ROI), drawn at either whole tu- mor or hypervascular part, can be compared between treatment intervals. In our initial experi- ence, reduction of mean Ktrans from baseline might be able to predict tumor stability/progression in patients with advanced HCC. Further data with regard to the predictive value of DCE-MRI for assessing antiangiogenic effect in advanced HCC is warrant

Correlation of MR Lumbar Spine Bone Marrow Perfusion with Bone Mineral Density in Female Subjects

PURPOSE: To prospectively assess lumbar spine bone marrow perfusion at dynamic magnetic resonance (MR) imaging and correlate perfusion with bone mineral density (BMD) in female subjects. MATERIALS AND METHODS: BMD measurement and dynamic MR imaging of the lumbar spine were performed in 69 female subjects (mean age standard deviation, 57 years 11). Subjects were stratified into premenopausal (n 19) and postmenopausal (n 50) groups, with the latter group including both women who were (n 13) and women who were not (n 37) receiving hormone replacement therapy. BMD (in grams per square centimeter) was measured with dual energy absorptiometry in the lumbar spine. Peak enhancement ratio, measured with time– signal intensity curves calculated from dynamic MR image data, represented bone marrow perfusion. Peak enhancement ratio was compared with age and BMD by using linear regression analysis and Pearson correlation. RESULTS: A significant positive correlation was found for BMD with peak enhancement ratio of lumbar vertebrae among all subjects (n 69, r 0.63, P .001), all postmenopausal women (n 50, r 0.50, P .001), and postmenopausal women without hormone replacement therapy (n 37, r 0.61, P .001). However, the correlation between BMD and peak enhancement ratio was not significant (P .05) in premenopausal women (n 19) or postmenopausal women receiving hormone therapy (n 13). Both BMD and peak enhancement ratio were inversely correlated with age (P .001, Pearson correlation). Pearson partial correlation coefficient for peak enhancement ratio and mean in all subjects, with control for inverse correlation with age, was significant (r 0.63, P .001). CONCLUSION: Significant correlation was found between the peak enhancement ratio of vertebral bone marrow and BMD in postmenopausal female subjects. This result may suggest a vascular component in the pathogenesis of osteoporosis

Effect of Calcium Channel Blockers on Vertebral Bone Marrow Perfusion of the Lumbar Spine

PURPOSE: To investigate the effect of calcium channel blockers on blood perfusion of vertebral bone marrow in the lumbar spine. MATERIALS AND METHODS: Sixteen healthy volunteers (eight men and eight women) underwent dynamic contrast material–enhanced magnetic resonance (MR) imaging of the lumbar spine. One hundred twenty minutes after the first MR examination, each subject ingested 10 mg sublingual nifedipine before undergoing a second MR examination 20–25 minutes later. Semiquantitative (peak enhancement ratio and enhancement slope) and quantitative (amplitude and rate constant of the exchange [Kout]) parameters were analyzed with the time-intensity curve. Data obtained before and after administration of nifedipine were compared. The Wilcoxon signed rank test and Spearman rank correlation test were used. RESULTS: Median peak enhancement ratio of vertebral bodies decreased from 0.60 (mean ± SD, 0.68 ± 0. 29) to 0.51 ( mean, 0.56 ± 0.24) after administration of nifedipine. Median and mean decreases were 0.11 and 0.12 ±0.15, respectively, and the percentage difference was 17% (P = .005). A P value of less than .05 was considered to indicate a statistically significant difference. Median enhancement slope changed from 0.45 (mean, 0.45 ± 0.13) to 0.41 (mean, 0.40 ± 0.24). Median and mean changes were 0.05 and 0.04 ± 0.23, respectively, and the percentage difference was 9% (P = .334). Median amplitude changed from 0. 059 (mean, 0.059 ± 0.028) to 0.045 (mean, 0.048 ± 0.023) . Median and mean changes were 0.008 and 0.011 ± 0.025, respectively, and the percentage difference was 18% (P = . 072). Median Kout changed from 0.068 (mean, 0.063 ± 0.018) to 0.067 (mean, 0.066 ± 0.028). Median and mean changes were 0.011 and 0.004 ± 0.028, respectively (P = .404). Nifedipine affected peak enhancement ratio significantly but did not affect enhancement slope, amplitude, or Kout. Data before and after administration of nifedipine showed no differences between men and women. Spearman rank correlation coefficients suggest no significance between the differences in heart rate and blood pressure and the differences in peak enhancement ratio, enhancement slope, amplitude, or Kout. CONCLUSION: After sublingual administration of nifedipine, the peak enhancement ratio of vertebral bone marrow decreased

Correlation of Mr Lumbar Spine Bone Marrow Perfusion with Bone Mineral Density in Female Subjects

PURPOSE: To prospectively assess lumbar spine bone marrow perfusion at dynamic magnetic resonance (MR) imaging and correlate perfusion with bone mineral density (BMD) in female subjects. MATERIALS AND METHODS: BMD measurement and dynamic MR imaging of the lumbar spine were performed in 69 female subjects (mean age ± standard deviation, 57 years ±11). Subjects were stratified into premenopausal (n = 19) and postmenopausal (n = 50) groups, with the latter group including both women who were (n = 13 ) and women who were not (n = 37) receiving hormone replacement therapy. BMD (in grams per square centimeter) was measured with dual energy absorptiometry in the lumbar spine. Peak enhancement ratio, measured with time–signal intensity curves calculated from dynamic MR image data, represented bone marrow perfusion. Peak enhancement ratio was compared with age and BMD by using linear regression analysis and Pearson correlation. RESULTS: A significant positive correlation was found for BMD with peak enhancement ratio of lumbar vertebrae among all subjects (n = 69, r = 0.63, P .05) in premenopausal women (n = 19) or postmenopausal women receiving hormone therapy (n = 13). Both BMD and peak enhancement ratio were inversely correlated with age (P < . 001, Pearson correlation). Pearson partial correlation coefficient for peak enhancement ratio and mean in all subjects, with control for inverse correlation with age, was significant (r = 0.63, P < .001). CONCLUSION: Significant correlation was found between the peak enhancement ratio of vertebral bone marrow and BMD in postmenopausal female subjects. This result may suggest a vascular component in the pathogenesis of osteoporosis

Bone Marrow Angiogenesis Magnetic Resonance Imaging in Patients with Acute Myeloid Leukemia: Peak Enhancement Ratio Is an Independent Predictor for Overall Survival

Emerging evidence suggests that progression of hematologic malignancies is associated with angiogenesis. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can provide global and functional imaging of tumor angiogenesis. In this study, we performed bone marrow DCE-MRI prospectively at diagnosis and after induction chemotherapy in 78 de novo acute myeloid leukemia (AML) patients and correlated it with treatment outcome. An algorithm to assess bone marrow angiogenesis by measuring the DCE-MRI time- intensity curve pixel by pixel was developed using 3 distinct parameters: peak enhancement ratio (Peak) to indicate tissue blood perfusion; amplitude (Amp) to reflect vascularity; and volume transfer constant (K trans) to indicate vascular permeability. The Peak and Amp decreased significantly at remission status after induction chemotherapy. Patients with higher Peak or Amp at diagnosis had shorter overall survival and disease-free survival than others. Cox multivariate analysis identified higher Peak value (hazard ratio, 9.181; 95% confidence interval, 1.740- 48.437; P = .009) as an independent predictor for overall survival in addition to unfavorable karyotype and old age. Our findings provide evidence that increased bone marrow angiogenesis measured by DCE-MRI can predict adverse clinical outcome in AML patients. DCE-MRI may help to select high-risk phenotype AML patients for tailored antiangiogenic therapy and to monitor treatment response