Breast fat volume measurement using wide-bore 3 T MRI: comparison of traditional mammographic density evaluation with MRI density measurements using automatic segmentation.

AIM: To compare magnetic resonance imaging (MRI)-derived breast density measurements using automatic segmentation algorithms with radiologist estimations using the Breast Imaging Reporting and Data Systems (BI-RADS) density classification. MATERIALS AND METHODS: Forty women undergoing mammography and dynamic breast MRI as part of their clinical management were recruited. Fat-water separated MRI images derived from a two-point Dixon technique, phase-sensitive reconstruction, and atlas-based segmentation were obtained before and after intravenous contrast medium administration. Breast density was assessed using software from Advanced MR Analytics (AMRA), Linköping, Sweden, with results compared to the widely used four-quartile quantitative BI-RADS scale. RESULTS: The proportion of glandular tissue in the breast on MRI was derived from the AMRA sequence. The mean unenhanced breast density was 0.31±0.22 (mean±SD; left) and 0.29±0.21 (right). Mean breast density on post-contrast images was 0.32±0.19 (left) and 0.32±0.2 (right). There was "almost perfect" correlation between pre- and post-contrast breast density quantification: Spearman's correlation rho=0.98 (95% confidence intervals [CI]: 0.97-0.99; left) and rho=0.99 (95% CI: 0.98-0.99; right). The 95% limits of agreement were -0.11-0.08 (left) and -0.08-0.03 (right). Interobserver reliability for BI-RADS was "substantial": weighted Kappa k=0.8 (95% CI: 0.74-0.87). The Spearman correlation coefficient between BI-RADS and MRI breast density was rho=0.73 (95% CI: 0.60-0.82; left) and rho=0.75 (95% CI: 0.63-0.83; right) which was also "substantial". CONCLUSION: The AMRA sequence provides a fully automated, reproducible, objective assessment of fibroglandular breast tissue proportion that correlates well with mammographic assessment of breast density with the added advantage of avoidance of ionising radiation.

Patients undergoing coronary revascularisation: a missed opportunity for secondary prevention?

BACKGROUND: This study tested the hypothesis that the opportunity to start secondary prevention therapy before discharge after coronary revascularisation is being missed. The study assessed current prescribing practice and identified discrepancies in prescribing for patients managed by surgeons (especially) and cardiologists. METHODS: 200 consecutive patients from the Manchester Heart Centre percutaneous coronary intervention (PCI) and coronary artery bypass (CABG) registries were identified (100 from each registry) and the notes analysed. All had undergone coronary revascularisation from February 2002 to March 2002. Data were analysed using SPSS for Windows, version 10.1. RESULTS: After exclusion of two patients with contraindications, 100% (98 of 98) of PCI patients and 92% (90 of 98) CABG patients were prescribed aspirin at discharge. Eight two per cent of eligible PCI patients and 70% of eligible CABG patients were prescribed beta blockers at discharge. Ninety six per cent (96 of 100) of PCI patients and 73% (73 of 100) of CABG patients were prescribed statins of any dose at discharge, (p<0.001). Sixty five per cent of PCI but only 26% of CABG patients were discharged prescribed ACE inhibitors (eligible patients based on HOPE, heart outcomes prevention evaluation trial), (p<0.001). CONCLUSIONS: Secondary prevention prescription after coronary revascularisation remains suboptimal in all but aspirin use. Patients in the PCI group were statistically more likely to be discharged prescribed a statin or an ACE inhibitor, or both, than patients after CABG. Both interventional cardiologists and (especially) cardiac surgeons must improve their use of secondary prevention therapy.