RESUMO
OBJECTIVE: The adjacent vessel sign (AVS) is a descriptor for differentiating malignant from benign breast lesions on breast MRI (bMRI). This investigation was designed to verify the previous reports on the diagnostic accuracy of AVS and to assess correlation between AVS, histopathological diagnosis, lesion size and lesion grade. MATERIALS AND METHODS: This study was approved by the local ethical committee. Experienced radiologists evaluated 1,084 lesions. The exclusion criteria were no histological verification after bMRI and breast interventions that were done up to one year before bMRI (surgery, core biopsy, chemo- or radiation therapy). The native and dynamic contrast-enhanced T1-weighted series were acquired using standardized protocols. The AVS was rated positive if a vessel leading to a lesion could be visualized. Prevalence of an AVS was correlated with the lesions' size, grade and histology using Chi-square-tests. RESULTS: The AVS was significantly associated with malignancy (p 2 cm more often presented with an AVS than did those malignant lesions < 2 cm (p < 0.0001; sensitivity: 65%, PPV: 90%). There was no correlation of the AVS with the tumor grade. The prevalence of an AVS didn't significantly differ between invasive lobular carcinomas versus ductal carcinomas. In situ cancers were less frequently associated with an AVS (p < 0.001). CONCLUSION: The adjacent vessel sign was significantly associated with malignancy. Thus, it can be used to accurately assess breast lesions on bMRI. In this study, the AVS was particularly associated with advanced and invasive carcinomas.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Mama/patologia , Neoplasias da Mama/patologia , Meios de Contraste , Diagnóstico Diferencial , Gadolínio DTPA , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Ductais, Lobulares e Medulares/patologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The aging process is related to several changes in cardiovascular, metabolic and autonomic functions. However, descriptions of changes in arterial pressure (AP), baroreflex sensitivity and associated variations of serum glucose and insulin are controversial. The aim of this paper was to study AP, sensitivity and changes in plasma levels of glucose and insulin of young (10 weeks, 239 ñ 4.3 g) and aged (18-24 months, 412 ñ 8.5 g) male Wistar rats AP pulses were videotaped and processed on a microcomputer, using an analog-to-digital converter (beat-to-beat analysis). Baroreflex sensitivity was evaluated measuring heart rate changes induced by mean arterial pressure (MAP) variations produced by phenylephrine and socium nitroprosside injection (N = 10 in each group). Plasma glucose (N = 10 in each group) and plasma insulin (N = 6 in each group) were quantified by a colorimetric enzymatic test and radioimmunoassay,respectively. Ther were no differences in systolic, diastolic or mean AP (110 ñ 5 vs 107 ñ 3 mmHg) between aged and young rats. The tachycardic reponse to the reduction of AP was impaired in aged compared to young rats (-1.95 ñ 0.29 vs -3.26 ñ 0.49 bpm/mmHg), while the bradycardic response to increases in AP was similar (-1.02 ñ 0.22 vs -1.5 ñ 0.26 bpm/mmHg). Basal levels of glucose (83 ñ 6 vs 62 ñ 4mg/dl) and insulin (8.3 ñ 2 vs 4 ñ 0.5 µU/ml) were different. Thus, the reflex tachycardia evoked by a fall in AP is depressed in old rats. The observed higher basal insulin and glucose levels in aged rats may contribute to the imapairment of the baroreflex control