Abstract
Objective To investigate the feasibility of low dose dedicated computed tomography (CT) with IMR technique compared with magnetic resonance imaging (MRI) in preoperative evaluation of breast cancer. Methods Dedicated CT and breast MRI were performed in 21 patients with diagnosed breast mass for preoperative evaluation. A dedicated protocol combined with chest diagnostic CT and dynamic scans of breast was developed with the use of IMR technique as well as optimization of scan parameters to ensure acceptable radiation dose. Image quality evaluations of CT images were performed using a five-point scale. The number, site and size (maximum diameter) of breast lesion were recorded respectively in CT and MRI images. The enhancement patterns of breast lesion were classified to 3 types (washout, plateau, and persistence) according to time intensity curve derived from CT and time signal curve derived from MRI, respectively. Pearson’s correlation, Bland-Altman analysis, and Cohen’s kappa test were used for statistical assessment. Results The mean effective radiation dose of dedicated breast CT, with the image quality diagnostic acceptable for evaluation of breast lesion and pulmonary structures, was (2.15±0.39) mSv, which was no more than a routine chest diagnostic CT. Results of breast lesion number and lesion site obtained by CT and MRI was consistent, with a total of 24 lesions detected in 21 patients. The mean lesion size was (26.5±12.1) mm in CT and (26.1±12.9) mm in MR, respectively. CT showed an excellent correlation with MRI for lesion size (r=0.99, n=24, p<0.0001). Limits of agreement determined by Bland-Altman analysis for lesion extent was (-3.0mm, 3.8mm). Good agreement was observed between CT and MRI for lesion enhancement patterns (kappa value = 0.936, p=0.000). Conclusion Dedicated breast CT imaging with acceptable radiation dose enabled diagnostic image quality and showed good agreement with breast MR imaging in preoperative evaluation of breast cancer.
Highlights
A breast mass is one of the most common presenting features of breast cancer but may not exhibit distinctive physical findings [1]
All the lesions were confirmed by biopsy and/or surgery, of which 20 invasive ductal carcinoma, 3 fibroadenoma, and 1 fibrocystic disease
The dedicated computed tomography (CT) breast imaging that we proposed demonstrated diagnostic image quality for both breast and pulmonary structures at an effective radiation dose of around 2mSv, which is equivalent to that of low dose chest CT scans in National Lung Screening Trial (NLST)[18], far less than that of routine diagnostic chest imaging
Summary
A breast mass is one of the most common presenting features of breast cancer but may not exhibit distinctive physical findings [1]. Diagnostic mammography and breast ultrasound are used as first line modalities to characterize the nature of the mass before biopsy [2] For those lesions with biopsy-proven malignancy in non-fatty tissue, magnetic resonance (MR) imaging is considered more sensitive than mammography or ultrasound for evaluating the extent of disease [3]. On the other hand, computed tomography (CT) imaging has been found to have high diagnostic efficacy in evaluation of breast tumoral lesions [5,6,7,8] and enlarged lymph nodes [9], plays an important role in preoperative evaluation in patients with breast cancer who cannot undergo MRI because of contraindications such as claustrophobia. CT breast imaging is not preferred due to its high radiation exposure
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