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Everything you need to know about Computed Tomography (CT) & CT Scanning

Chest: Breast Cancer Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Chest ❯ Breast Cancer

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  • Summary
    A deep learning algorithm was used to assess mammographic breast density at the level of an experienced mammographer during routine clinical practice.
    Implications for Patient Care:
    * A deep learning algorithm was used to reliably and accurately assess mammographic breast density in a large clinical practice.
    * Given the high level of agreement between the deep learning algorithm and experienced mammographers, this algorithm has the potential to standardize and automate routine breast density assessment.
    Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation
    Lehman CD et al.
    Radiology 2019; 290:52–58
  • “Inconsistency in density assessment of mammograms has been widely recognized for the potential to cause patient anxiety and result in unnecessary procedures. To address this issue, we developed a DL model to assess mammographic breast density that was trained by using the assessments of experienced breast imagers. Our DL model was deployed in the mammography clinic to assess performance and acceptance in a large academic breast imaging practice. In this setting, the DL model density assessment was accepted as the final reading in 90% of mammograms by an experienced breast imager.”
    Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation
    Lehman CD et al.
    Radiology 2019; 290:52–58
  • “Also, this model was trained on mammograms at one academic center that used mammography units from one vendor (Hologic), and further testing on diverse mammograms acquired with machines from multiple vendors and from different institutions is needed. Finally, during the clinical implementation of our project, acceptance of the DL density assessment was measured in an unblinded manner."
    Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation
    Lehman CD et al.
    Radiology 2019; 290:52–58
  • In summary, we present an analysis of clinical implementation of a DL model used to assess breast density in women undergoing screening digital mammography. Our DL model provides efficient and reliable density assessments, both at the patient level and at the population level, and it is designed to be widely available, simple to use, and cost effective. It can be used to measure breast density in a diverse set of patients, without limitations based on prior surgery or other breast interventions. Our tool can potentially address concerns for current breast density legislation, and it can help providers supply more accurate information to patients and help health systems optimize the use of supplemental screening resources. To this end, we have made our tool publicly available for research use at http://learningtocure. csail.mit.edu.
    Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation
    Lehman CD et al.
    Radiology 2019; 290:52–58
  • “Our tool can potentially address concerns for current breast density legislation, and it can help providers supply more accurate information to patients and help health systems optimize the use of supplemental screening resources. To this end, we have made our tool publicly available for research use at http://learningtocure. csail.mit.edu.
    Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation
    Lehman CD et al.
    Radiology 2019; 290:52–58
  • “Multidetector CT and dynamic contrast en- hanced techniques have been used to study features of malignancy in breast tumors. Ir- regular margins, irregular shape, and rim en- hancement are the most highly predictive features for malignancy in these studies. A spiculated and irregular margin is the most accurate sign for malignancy.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “A washout pattern on postcontrast images had high positive predictive value and sensitivity, although low negative predictive value and specificity. Diffuse regional en- hancement is also shown to have high positive predictive value for malignancy.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “At CT, invasive ductal carcinoma appears as a dense, spiculated mass with marked early and/or peripheral enhancement. The presence of rim enhancement and internal enhancing septations can be suggestive signs. In advanced cases, associated skin thickening, lymphadenopathy, or pleural effusions may be seen.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “Inflammatory carcinoma is an uncommon, aggressive tumor with early dermal lymphatic invasion and poor prognosis. Clinical diagnosis is based on increased warmth, induration of breast skin, erysipeloid edge (peau d’orange), and nipple retraction. In some cases, inflammatory carcinoma may be indistinguishable from mastitis and abscess but fails to respond to antibiotics. Inflammatory carcinoma should be considered in the differential diagnosis when breast edema is accompanied by clinical signs of infection.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “Breast hematomas and seromas can be seen after biopsy, trauma, or surgery . Their diagnosis can be made by correlating the finding to the clinical history. Immediately after surgery or biopsy, the surrounding edema may obscure a hematoma. Hematomas will become smaller over time and eventually resorb and therefore can be 
distinguished from other masses.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “If the scar can be shown to occupy a surgical site, then the spiculated appearance is not of concern. In differentiating a scar from cancer, correlating prior biopsy locations from the patient history, reviewing prior images, and noting linear scar markers in the locations of prior biopsy are very important. Masses not corresponding to a postbiopsy scar should be considered suspicious. In addition, any new tissue growth in a previously identified postoperative scar (particularly after cancer resection) should be viewed with suspicion.”


    Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “In general, larger round or oval calcifications that are uniform in size and shape have a higher probability of being associated with a benign process, whereas smaller, irregular, polymorphic, clustered calcifications heterogeneous in size and morphology are more often associated with a malignant process. Nearly all calcifications currently seen at CT are benign, on the basis of size alone, due to the limited spatial resolution .”
Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “CT is very sensitive for the detection of coarse calcifications. When calcifications are identified in the breast at CT, they are nearly all benign. They should be characterized when resolution allows as lucent-centered calcifications, eggshell or rim calcifications, coarse or popcornlike calcifications, large rodlike calcifications, or round calcifications.”

    
Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51 

  • “In our experience, breast abnormalities at CT are frequently overlooked or inaccurately assessed. Our aim has been to expose the general radiologist to the imaging characteristics of a range of breast abnormalities in addition to providing a succinct and accurate method of describing and classifying these findings. It is important that general radiologists pay attention to the breasts on CT scans and that they are trained to recognize and report abnormal findings with confidence.”

    
Breast Lesions Incidentally Detected with CT: What the General Radiologist Needs to Know
Harish MG et al.
RadioGraphics 2007; 27:S37–S51
  • CT of Breast Cancer

    Pulmonary metastases occur in 30% of all malignancies, usually through hematogenous dissemination. In 10-25% of cases, the lungs are the only site of metastasis. The classic CT appearance is that of multiple well-defined nodules, often seen in continuity with an underlying blood vessel. Lung metastases are typically widespread, although solitary metastases are not at all uncommon, particulary in colon, kidney, breast, testicular, and musculoskeletal primaries.

     

  • CT of Breast Cancer: facts

    Internal mammary adenopathy is an important site of occult metastasis in breast cancer. Involvement is often ipsilateral to the primary tumor and represents a site of regional nodal spread, much like the axilla. Lymphoma represents the other common malignancy to selectively target this nodal chain. Involvement is usually the result of contiguous spread from the anterior mediastinal or paratracheal area to the other mediastinal lymph node groups, including the internal mammary chain. Occasionally, isolated internal mammary nodal involvement is seen.
  • Dynamic CT-mammography: CT Protocol

    - 100 cc of non-ionic contrast injection at 3 cc/sec
    - Scans were acquired at 30 sec and 2 minutes post start of injection
    - Images reviewed with axial CT and MIP displays
  • "Multiple enhancing lesions on CT-mammography in patients with breast cancer were relatively common, and most of them represented multiple cancer lesions. Dynamic CT-mammography is potentially useful in evaluating the spread of breast cancer.”

    Multiple Enhancing Lesions Detected on Dynamic Helical Computed Tomography-Mammography
    Nishino M et al.
    J Comput Assit Tomogr 2003; 27:771-778
  • “The CT features of breast lesions are less familiar than are those of mammography and ultrsonography; however, CT can demonstrate many abnormal breast conditions. Also, some breast lesions are better visualized on CT than on mammography.”

    Computed Tomography of the Breast: Abnormal Findings with Mammographic and Sonographic Correlation
    Kim SM et al.
    J Comput Assist Tomogr 2003;27:761-770
  • MDCT of Breast Cancer: CT Appearance

    - Spiculated and Irregular margin
    - Irregular shape
    - Rim enhancement
  • "Administration of IV contrast material by means of hand injection led to damage of four central venous catheters during a 6 yr period at our institution (0.3% of central venous catheters hand injected during that time)."

    Is Hand Injection of Central Venous catheters for Contrast Enhanced CT Safe for Children
    Donnelly LF et al.
    AJR 2007;189:1530-1532
  • "Dedicated breast CT is currently investigational but may eventually have applications in screening or diagnostic evaluation for breast cancer, as a more accessible replacement for breast MR imaging or as a guidance method for robotic breast biopsy or tumor ablation procedures."

    Dedicated Breast CT: Initial Clinical Experience Lindfors KK et al.
    Radiology 2008;246:725-733
  • "Subjects found CT significantly more comfortable than mammography."

    Dedicated Breast CT: Initial Clinical Experience Lindfors KK et al.
    Radiology 2008;246:725-733
  • "Overall, CT was equal to mammography for visualization of breast lesions.Breast CT was significantly better than mammography for visualization of masses; mammography outperformed CT for visualization of microcalcifications. No significant differences between CT and mammography were seen among benign versus malignant lesions or for effect of breast density on lesion visualization."

    Dedicated Breast CT: Initial Clinical Experience Lindfors KK et al.
    Radiology 2008;246:725-733
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