ABSTRACT
Background: Neoadjuvant chemotherapy [NAC] is the favored treatment of choice among locally advanced breast cancer patients because it significantly increases the possibility of breast-conserving surgery. However, for non-responders, an early prediction of response to NAC is essential. Magnetic resonance imaging [MRI] of the breast is an adjunct diagnostic procedure to mammography and ultrasound. Because of its high sensitivity and effectiveness in dense breast tissue, MRI can be a valuable addition to the diagnostic work-up of a patient with breast abnormality or biopsy-proven cancer
Aim of the Work: To highlight the role of advanced MRI techniques in the prediction and follow up of the response of breast cancer to neoadjuvant chemotherapy
Conclusion: Early change in tumor size measured on MR images is a good predictor of final response after Neoadjuvant chemotherapy [NAC]. However, even if the cells respond to treatment, it takes some time for the tumor to shrink. Substantial research effort has been spent on investigating whether other information provided by MR imaging may serve as earlier response indicators than change in tumor size. Techniques that seem to be closest to clinical application, due to their feasibility and the promising results, are the pharmacokinetic analysis of DCE-MRI [Dynamic Contrast Enhanced- MRI], DW-MRI [Diffusion Weighted- MRI] and Spectroscopy
ABSTRACT
Transcranial ultrasound [TU] is a noninvasive, easy-to-repeat diagnostic technique that is being used widely for the evaluation of cerebral heamodynamic. The aim of the study was to explore and demonstrate the findings that can be afforded by the Transcranial ultrasonography, the non imaging Transcranial Doppler sonography [TCD] and the imaging Transcranial color-coded Doppler sonography [TCCS], with more emphasis on the practical work of the TCCS. During a period of one academic year from October 2005 to October 2006, 50 non consecutive patients, seen at the stroke clinics of two medical institutions, were enrolled in the study. They were divided into two groups. The 1st group comprised of 25 patients recruited from Ain Shams specialized hospital who had TCD. The 2nd group comprised of another 25 patients recruited from Cairo University Hospital who had TCCS. Extra cranial Carotid Duplex had been done for both groups. In the two groups, the effect of the supplying artery on the insonated intracranial arteries was put in consideration whenever TCD or TCCS was done. Out of the 50 patients, 40 [80%] were successfully insonated yet in 10 [20%] patients, insonation through the temporal acoustic window failed; of which 6 [60%] were females and 4 [40%] were males. We found 11 [14%] MCAs which revealed abnormal waveform patterns [10 dampened and 1 blunted], reversal of flow in the ACA was noticed in three cases and a dampened waveform pattern in 12 PCAs. Regarding intracranial arterial stenosis, it was detected in 21 arteries [13 MCAs, 2 ACAs, 6 PCAs], 16 showed < 50% stenosis [9 MCAs, 2 ACAs, 5 PCAs] and 5 showed >/= 50% stenosis [4 MCAs, I PCAs]. We recommend that acute stroke patient, must perform a baseline TCU which, provide a hemodynamic intracranial image to what is present extracranially, Repeated examination can be achieved by TCU to serially monitor the therapeutic or spontaneous recanalization