Comparison of breast tissue measurements using magnetic resonance imaging, digital mammography and a mathematical algorithm.

Women with mostly mammographically dense fibroglandular tissue (breast density, BD) have a four- to six-fold increased risk for breast cancer compared to women with little BD. BD is most frequently estimated from two-dimensional (2D) views of mammograms by a histogram segmentation approach (HSM) and more recently by a mathematical algorithm consisting of mammographic imaging parameters (MATH). Two non-invasive clinical magnetic resonance imaging (MRI) protocols: 3D gradient-echo (3DGRE) and short tau inversion recovery (STIR) were modified for 3D volumetric reconstruction of the breast for measuring fatty and fibroglandular tissue volumes by a Gaussian-distribution curve-fitting algorithm. Replicate breast exams (N = 2 to 7 replicates in six women) by 3DGRE and STIR were highly reproducible for all tissue-volume estimates (coefficients of variation <5%). Reliability studies compared measurements from four methods, 3DGRE, STIR, HSM, and MATH (N = 95 women) by linear regression and intra-class correlation (ICC) analyses. Rsqr, regression slopes, and ICC, respectively, were (1) 0.76-0.86, 0.8-1.1, and 0.87-0.92 for %-gland tissue, (2) 0.72-0.82, 0.64-0.96, and 0.77-0.91, for glandular volume, (3) 0.87-0.98, 0.94-1.07, and 0.89-0.99, for fat volume, and (4) 0.89-0.98, 0.94-1.00, and 0.89-0.98, for total breast volume. For all values estimated, the correlation was stronger for comparisons between the two MRI than between each MRI versus mammography, and between each MRI versus MATH data than between each MRI versus HSM data. All ICC values were >0.75 indicating that all four methods were reliable for measuring BD and that the mathematical algorithm and the two complimentary non-invasive MRI protocols could objectively and reliably estimate different types of breast tissues.

SEMAC-VAT and MSVAT-SPACE sequence strategies for metal artifact reduction in 1.5T magnetic resonance imaging.

OBJECTIVES: To evaluate the ability of four magnetic resonance imaging (MRI) techniques to correct for metallic artifacts. These techniques consisted of 3 2D techniques and one 3D technique. In 2D imaging the techniques View Angle Tilting (VAT), Slice Encoding for Metal Artifact Correction (SEMAC) and a technique that employed a combination of the first two (SEMAC-VAT) were evaluated. In 3D imaging the technique Multiple Slab acquisition with VAT based on a SPACE sequence was evaluated (MSVAT-SPACE). MATERIALS AND METHODS: Agarose phantoms and tissue phantoms with two commonly used metal implants (stainless steel and titanium) as well as two volunteers with metal implants were imaged at 1.5T. All phantoms and volunteers were imaged using VAT, SEMAC, SEMAC-VAT and MSVAT-SPACE techniques, as well as 2D and 3D conventional imaging techniques. Each technique was optimized for different image contrast mechanisms. Artifact reduction was quantitatively assessed in the agarose phantoms by volumetric measurement. Image quality was qualitatively assessed by blinded reads employing two readers. Each reader independently viewed the tissue phantom images and in vivo human images. Statistical analysis was performed using a Friedman test, Wilcoxon test and weighted Cohen's kappa test. RESULTS: T1-weighted, T2-weighted, PD-weighted and STIR image contrasts were successfully implemented with the evaluated artifact reduction sequences in both the phantom experiments and in vivo images. For all evaluated image contrasts and both metal implants, a reduction in the volume of metal artifacts was seen when compared with 2D conventional acquisitions. The 2D metal artifact volumes on average were reduced by 49% ± 16%, 56% ± 15% and 63% ± 15% for VAT, SEMAC and SEMAC-VAT acquisitions respectively. When Friedman and Wilcoxon tests were applied the difference in metal artifact volume was found to be statistically significant when VAT, SEMAC and SEMAC-VAT were compared with the 2D conventional techniques. In 3D imaging on average MSVAT-SPACE reduced metal artifact volume compared with the 3D conventional imaging technique by 72% ± 23% for all evaluated image contrasts and both metal implants. The metal artifact volume differences were statistically significant when MSVAT-SPACE was compared with the 3D conventional technique. The blinded reads demonstrated that SEMAC-VAT and MSVAT-SPACE had distinctly superior quality compared with conventional acquisitions. Quality was measured in terms of artifact size, distortions, image quality and visualization of bone marrow and soft tissues adjacent to metal implants. This was the case for both tissue phantom images and human images with good interobserver agreement. CONCLUSIONS: SEMAC-VAT (2D) and MSVAT-SPACE (3D) demonstrated a consistent, marked reduction of metal artifacts for different metal implants and offered flexible image contrasts (T1, T2, PD and STIR) with high image quality. These techniques likely will improve the evaluation of postoperative patients with metal implants.

Ross procedure with a composite autograft using stretch Gore-Tex material.

In an attempt to allow physiologic expansion of the pulmonary autograft, yet limit late root dilation, we used stretch Gore-Tex material (W. L. Gore & Assoc, Flagstaff, AZ) as an external wrap. Follow-up cardiac computed tomography with reconstructed three-dimensional and dynamic images confirmed normal "triple bulge" sinus Valsalva geometry and preserved natural systolic expansion of the neoaortic root.

Evaluation of three-dimensional computed tomography processing for deep inferior epigastric perforator flap breast reconstruction.

BACKGROUND: The deep inferior epigastric perforator flap procedure has become a popular alternative for women who require breast reconstruction. One of the difficulties with this procedure is identifying perforator arteries large enough to ensure that the harvested tissue is well vascularized. Current techniques involve imaging the perforator arteries with computed tomography (CT) to produce a grid mapping the locations of the perforator arteries relative to the umbilicus. OBJECTIVES: To compare the time it takes to produce a map of the perforators using either two-dimensional (2D) or three-dimensional (3D) CT, and to see whether there is a benefit in using a 3D model. METHODS: Patient CT abdomen and pelvis scans were acquired from a GE 64-slice scanner. CT image processing was performed with the GE 3D Advantage Workstation v4.2 software. Maps of the perforators were generated both as 2D and 3D representations. Perforators within a region 5 cm rostral and 7 cm caudal to the umbilicus were measured and the times to perform these measurements using both 2D and 3D images were recorded by a stopwatch. RESULTS: Although the 3D method took longer than the 2D method (mean [+/- SD] time 1:51+/-0:35 min versus 1:08+/-0:16 min per perforator artery, respectively), producing a 3D image provides much more information than the 2D images alone. Additionally, an actual-sized 3D image can be printed out, removing the need to make measurements and producing a grid. CONCLUSIONS: Although it took less time to create a grid of the perforators using 2D axial CT scans, the 3D reconstruction of the abdomen allows the plastic surgeons to better visualize the patient's anatomy and has definite clinical utility.

Thickness of molybdenum filter and squared contrast-to-noise ratio per dose for digital mammography.

OBJECTIVE: The objective of our study was to test whether the lesion-tissue contrast-to-noise ratio (CNR) at a given dose level can be improved by increasing the thickness of the molybdenum (Mo) filter currently used in digital mammography. MATERIALS AND METHODS: We studied how the CNR between breast and a 5-mm simulated infiltrating ductal carcinoma (IDC) embedded in a 5-cm-thick breast changes with Mo filter thickness. We performed phantom imaging experiments by modifying the filter wheel of a Senographe 2000D unit with Mo filters that ranged from 15 to 90 microm in thickness. A 5-cm-thick 50% glandular-50% adipose breast phantom with a 5-mm insert simulating IDC was used as the phantom for all the cases. The CNRs between the breast phantom and the IDC insert were measured, and average glandular doses were calculated using a filtration-dependent X-ray spectra model and a breast dosimetry model based on a validated Monte Carlo simulation. RESULTS: The lesion-tissue CNR at a given dose level increases with increasing Mo filter thickness from 15 to 90 microm. The measured squared CNR per dose increased by 8%, 14%, 17%, and 17% for 45-, 60-, 75-, and 90-microm Mo filters, respectively, compared with the standard 30-microm Mo filter. Meanwhile, the exposure times were increased by 35% (45 microm), 71% (60 microm), 177% (75 microm), and 229% (90 microm). CONCLUSION: Increasing Mo filter thickness from 30 to 60 microm can increase lesion-tissue squared CNR per dose by 14% with a tolerable increase in the duration of exposure.

Aeration following intact canal wall mastoidectomy.

This study examines the prevalence and extent of re-aeration of the mastoid cavity following intact canal wall (ICW) mastoidectomy. Temporal bone computed tomography scans from patients with prior unilateral ICW mastoidectomy were identified. Three-dimensional volume reconstruction of the temporal bone was performed to measure aeration bilaterally. Thirty-five scans were analyzed; 16 (46%) showed good aeration in the operated ear and 19 showed poor aeration. The aeration (volume) in the surgical ears and the contralateral ears was significantly less than that in subjects without a history of ear disease. Those with poor aeration were more likely to require additional surgery. For temporal bone pairs with greater volume in the operated ear, the average difference was 1.3 cm3. Surgical creation of a mastoid cavity does not produce a large increase in aeration as compared with the contralateral ear. Following surgery, mastoid opacification may presage recurrent disease. Routine use of mastoidectomy in an attempt to improve aeration is not advocated.

Evaluation of the internal auditory canal with virtual endoscopy.

OBJECTIVE: Three-dimensional imaging can improve the understanding and comprehension of complex anatomy. Recent advances in software development allow the construction of a virtual endoscopic view of anatomic structures. This report applies virtual endoscopic capabilities to imaging of the internal auditory canal. STUDY DESIGN, SETTING, AND PATIENTS: We conducted a retrospective case review at a tertiary referral center of patients with abnormal internal auditory canal anatomy on computed tomography. INTERVENTIONS: Computed tomography images were obtained using conventional clinical algorithms involving multiple, 1-mm-thick slices through the temporal bone. Three-dimensional reconstructions were made using General Electric Advantage Windows Navigator software. The virtual endoscopic image-processing algorithm used selected image intensity threshold levels to visualize internal auditory canal anatomy from an endoscopic perspective. RESULTS: Eleven cases of abnormalities of the internal auditory canal were retrospectively identified. Clinical applications using the virtual endoscopic images are presented. The virtual endoscopic images supported prior clinical decision making in 6 of the 11 cases evaluated. CONCLUSION: This technique shows promise for the diagnosis, surgical planning, and teaching of temporal bone anatomy. Usefulness is dependent on acquisition parameters and clinical indications for examination.

3D CT imaging method for measuring temporal bone aeration.

OBJECTIVE: 3D volume reconstruction of CT images can be used to measure temporal bone aeration. This study evaluates the technique with respect to reproducibility and acquisition parameters. MATERIAL AND METHODS: Helical CT images acquired from patients with radiographically normal temporal bones using standard clinical protocols were retrospectively analyzed. 3D image reconstruction was performed to measure the volume of air within the temporal bone. The appropriate threshold values for air were determined from reconstruction of a phantom with a known air volume imaged using the same clinical protocols. The appropriate air threshold values were applied to the clinical material. RESULTS: Air volume was measured according to an acquisition algorithm. The average volume in the temporal bone CT group was 5.56 ml, compared to 5.19 ml in the head CT group (p = 0.59). The correlation coefficient between examiners was > 0.92. There was a wide range of aeration volumes among individual ears (0.76-18.84 ml); however, paired temporal bones differed by an average of just 1.11 ml. CONCLUSIONS: The method of volume measurement from 3D reconstruction reported here is widely available, easy to perform and produces consistent results among examiners. Application of the technique to archival CT data is possible using corrections for air segmentation thresholds according to acquisition parameters.