Contrast-enhanced spectral mammography in clinical practice: results in a screening population

This dissertation studies a new method to detect breast cancer called Contrast Enhanced Spectral Mammography (CESM). Abnormal breast tissue can be detected with CESM by administering intravenous iodinated contrast. This dissertation explains the way in which CESM works. Furthermore, the use of CESM in clinical practice is studied in women who have been referred after taking part in the national breast cancer screening programme. The study topics include safety, practicability and reproducibility. CESM is shown to be not only more accurate than a regular mammogram, but also a potential replacement for MRI under certain conditions

CT-Guided Percutaneous Transthoracic Needle Biopsies Using 10G Large-Core Needles: Initial Experience

PURPOSE: Using large-core biopsy needles in CT-guided percutaneous transthoracic needle biopsies (PTNB) may be advantageous in terms of larger specimens, which facilitate more extensive histopathological, immunohistochemical, and molecular examination of tumor tissue. The aim of this study was to evaluate the success rate and safety in CT-guided PTNB using 10G large-core biopsy needles. METHODS AND MATERIALS: 35 patients with intrathoracic lesions suspected of malignancy underwent CT-guided PTNB using dedicated large-core biopsy needles (10G Spirotome™, Medinvents, Hasselt, Belgium). Location, tumor size, number of pleural passes, number of biopsies, histologic result, and complications (pneumothorax, bleeding) were recorded. RESULTS: Lesion location varied from pleural to hilar location. Mean tumor size was 3.5 cm (range 0.7–9.2 cm). Only one pleural passage was necessary in all patients. Mean distance from the pleura to the lesion was 2.6 cm (max 9.2 cm). Large-core biopsy (10G) was successful in 88.6 %. Pneumothorax was found in 40 %. Minor intraparenchymal bleeding was present in 14 patients. No major complications were recorded. CONCLUSION: Large-core biopsy with 10G did not show higher complication rates compared to literature. It is technically feasible and safe. The obtained larger specimens may especially be helpful for the increasing demands of extensive molecular analysis for stratified patient care

Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients

Objective To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. Methods ThePubMedandEmbasedatabases were searched for relevant publications until April 2020. Two independent reviewers searched for eligible articles based on predefined in- and exclusion criteria, assessed quality and extracted data. Results Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. Conclusion In general, there is a trend toward higher sensitivity and lower specificity of PET/MRI when compared to PET/CT. Results on the diagnostic performance of DWI are conflicting. Rather than evaluating it separate, it seems to have complementary value when combined with other MR sequences

Value of gadofosveset-enhanced MRI and multiplanar reformatting for selecting good responders after chemoradiation for rectal cancer

OBJECTIVES: Our primary objective was to evaluate diagnostic performance of gadofosveset T1-weighted magnetic resonance imaging (T1W MRI) for discriminating between ypT0-2 and ypT3-4 tumours after chemoradiation therapy (CRT) for rectal cancer compared with T2W MRI for a general and expert reader. Second objectives included assessing the value of multiplanar reformatting (MPR) and interobserver agreement. METHODS: A general and expert reader evaluated 49 patients for likelihood of ypT0-2 tumour after CRT on T2W, gadofosveset T1W MRI, and gadofosveset T1W MRI + T2W MRI. The general reader scored with and without MPR. Confidence level scores were used to construct receiver-operating characteristic (ROC) curves. Area under the curve (AUC) values and diagnostic parameters were calculated and compared. RESULTS: Gadofosveset T1W MRI + T2W MRI showed slightly superior sensitivity than T2W MRI for the general but not the expert reader. Specificity was higher for the expert on gadofosveset T1W MRI only compared with T2W MRI only (100 % vs. 82 %). MPR did not increase diagnostic performance. Interobserver agreement was highest for the combination of gadofosveset-enhanced T1W imaging plus T2W MRI. CONCLUSIONS: The sole use or addition of gadofosveset-enhanced T1W MRI to T2W MRI did not increase significantly diagnostic performance for assessing ypT0-2 tumours. Adding gadofosveset-enhanced T1W MRI slightly increased sensitivity for the general reader and specificity for the expert reader, but this increase was not significant for more accurate clinical decision making. MPR did not improve diagnostic performance. KEY POINTS: * ycT restaging with MRI in rectal cancer is challenging. * Gadofosveset-enhanced T1W MRI has shown promise for nodal restaging. * Gadofosveset-enhanced T1W MRI did not significantly increase diagnostic performance for assessing ypT0-2-tumours. * Addition of the gadofosveset sequence to T2W MRI slightly increased sensitivity for the general reader. * MPR did not improve diagnostic performance of ycT staging