Publications by authors named "Tomoyuki Fujioka"

46 Publications

Relationship between Prognostic Stage in Breast Cancer and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

J Clin Med 2021 Jul 19;10(14). Epub 2021 Jul 19.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

This retrospective study examined the relationship between the standardized uptake value max (SUVmax) of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) and the prognostic stage of breast cancer. We examined 358 breast cancers in 334 patients who underwent F-FDG PET/CT for initial staging between January 2016 and December 2019. We extracted data including SUVmax of F-FDG PET and pathological biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and nuclear grade. Anatomical and prognostic stages were determined per the American Joint Committee on Cancer (eighth edition). We examined whether there were statistical differences in SUVmax between each prognostic stage. The mean SUVmax values for clinical prognostic stages were as follow: stage 0, 2.2 ± 1.4; stage IA, 2.6 ± 2.1; stage IB, 4.2 ± 3.5; stage IIA, 5.2 ± 2.8; stage IIB, 7.7 ± 6.7; and stage III + IV, 7.0 ± 4.5. The SUVmax values for pathological prognostic stages were as follows: stage 0, 2.2 ± 1.4; stage IA, 2.8 ± 2.2; stage IB, 5.4 ± 3.6; stage IIA, 6.3 ± 3.1; stage IIB, 9.2 ± 7.5, and stage III + IV, 6.2 ± 5.2. There were significant differences in mean SUVmax between clinical prognostic stage 0 and ≥II ( < 0.001) and I and ≥II ( < 0.001). There were also significant differences in mean SUVmax between pathological prognostic stage 0 and ≥II ( < 0.001) and I and ≥II ( < 0.001). In conclusion, mean SUVmax increased with all stages up to prognostic stage IIB, and there were significant differences between several stages. The SUVmax of F-FDG PET/CT may contribute to prognostic stage stratification, particularly in early cases of breast cancers.
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http://dx.doi.org/10.3390/jcm10143173DOI Listing
July 2021

A Rare Case of Primary Breast Osteosarcoma Evaluated with Multiple Modalities.

Diagnostics (Basel) 2021 Jun 28;11(7). Epub 2021 Jun 28.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a lobulated mass containing coarse calcification in the right breast. Magnetic resonance imaging showed a strong enhancement effect and high signal on diffusion-weighted imaging. Further imaging on 18F-fluorodeoxyglucose positron-emission tomography and computed tomography exhibited a high uptake. A right total mastectomy was performed. Histologic examination revealed abundant periosteal formation, areas of calcification and moderately pleomorphic oval to spindle-shaped stromal cells, leading to the diagnosis of PBO. The presence of calcified breast tumors exhibiting aggressive growth indicates that PBO should be added to the differential diagnosis.
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http://dx.doi.org/10.3390/diagnostics11071170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305560PMC
June 2021

Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography.

Diagnostics (Basel) 2021 Jun 14;11(6). Epub 2021 Jun 14.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan.
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http://dx.doi.org/10.3390/diagnostics11061085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232124PMC
June 2021

Study of the protocol used to evaluate skin-flap perfusion in mastectomy based on the characteristics of indocyanine green.

Photodiagnosis Photodyn Ther 2021 Jun 11;35:102401. Epub 2021 Jun 11.

Department of Specialized Surgeries, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.

Background: Indocyanine green angiography enables real-time visualization of blood vessels at depths of up to 10 mm beneath the body surface, thereby aiding the evaluation of the viability of skin flaps and predicting necrosis in surgical fields requiring good tissue perfusion. Although skin-flap necrosis also occurs in mastectomy without reconstruction, most studies have focused on reconstructive plastic surgery. Several patients undergoing mastectomy are eligible for postoperative adjuvant therapy, but complications can lead to delays in treatment and thus require prevention. However, a lack of a standard protocol for evaluating skin-flap perfusion using indocyanine green necessitates the study of its characteristics to facilitate comparison of the perfusion rate among individuals.

Methods: This retrospective study focused on the characteristics of indocyanine green and established a protocol for indocyanine green angiography using laser-assisted imaging (SPY system) to predict postoperative skin-flap necrosis from intraoperative images of 30 patients who underwent mastectomy without reconstruction.

Results: Our protocol predicted postoperative skin-flap necrosis as follows. First, the intravenous dose and concentration were set at 2.5 mg/mL and 0.05 mg/kg, respectively. Second, the timing of measurement was set to 100 s after the entry of indocyanine green into the skin (plateau phase); the analysis pattern was set to single frame. Third, comparisons among individuals were made using relative values.

Conclusions: We analyzed the area of postoperative flap necrosis using this protocol. We found that the intraoperative images showed decreased perfusion in that area, which was useful in predicting skin-flap necrosis, as reported by previous breast reconstruction studies.
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http://dx.doi.org/10.1016/j.pdpdt.2021.102401DOI Listing
June 2021

Short- and long-term outcomes of immediate breast reconstruction surgery after neoadjuvant chemotherapy.

Surg Today 2021 Jun 5. Epub 2021 Jun 5.

Department of Plastic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.

Purpose: Immediate breast reconstruction (IBR) is a standard option for breast cancer patients, although its utility in patients with advanced breast cancer requiring neoadjuvant chemotherapy (NAC) is debatable. We assessed the short-term complications and long-term prognosis of IBR after NAC.

Methods: We retrospectively analyzed 1135 patients with IBR and/or NAC between 2010 and 2018, 43 of whom underwent IBR after NAC.

Results: Twenty-five patients underwent reconstruction with a tissue expander (TE) followed by silicon breast implantation, 5 with a latissimus dorsi muscle transfer flap, and 13 with a deep inferior epigastric perforator flap. Complete surgical resection with a free margin confirmed by a pathological assessment was achieved in all patients. The evaluation of the short-term complications indicated no cases of total flap necrosis, two cases of partial flap necrosis, and one case of wound infection. Only one case required postponement of subsequent therapy due to partial flap necrosis. A long-term evaluation indicated no local recurrence, although distant metastasis was observed in 4 cases, 3 patients died, and TE removal after post-mastectomy radiotherapy (PMRT) was performed in 2 of 11 TE cases.

Conclusion: IBR may be a viable option in patients with advanced breast cancer who achieve complete surgical resection after NAC.
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http://dx.doi.org/10.1007/s00595-021-02316-3DOI Listing
June 2021

Clinical usefulness of the fast protocol of breast diffusion-weighted imaging using 3T magnetic resonance imaging with a 16-channel breast coil.

Clin Imaging 2021 Apr 30;78:217-222. Epub 2021 Apr 30.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113 - 8510, Japan.

We aimed to evaluate the usefulness of a fast protocol of diffusion-weighted imaging (DWI) with one excitation using 3T magnetic resonance imaging (MRI) and a 16-channel breast coil. We analyzed 30 lesions from 27 women between February 2020 and June 2020. The visibility score (from 1 = extremely poor to 5 = excellent) and apparent diffusion coefficient (ADC) value between one and four excitations were evaluated by two readers. The image acquisition time was 40 s for one excitation and 1 min 52 s for four excitations. The visibility scores were 4.630 ± 0.718 and 4.267 ± 1.015 for one excitation and 4.730 ± 0.691 and 4.200 ± 1.000 for four excitations by the two readers. There was no significant difference in the visibility (P = 0.184 and P = 0.423), mean ADC value (P = 0.918 and P = 0.417), and minimum ADC value (P = 0.936 and P = 0.443) between one and four excitations by the two readers. Despite the short acquisition time, the visibility score and ADC values of one-excitation DWI were comparable to that with four excitations. Our fast DWI protocol could provide reproducible visibility and ADC value, potentially helping radiologists to efficiently diagnose patients.
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http://dx.doi.org/10.1016/j.clinimag.2021.04.022DOI Listing
April 2021

Incidental T2 hyperintensities in the medial part of the bilateral globus pallidus are possibly an age-related physiological finding.

Neuroradiol J 2021 May 5:19714009211014129. Epub 2021 May 5.

Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Japan.

Background And Purpose: Bilateral T2 hyperintensities in the medial part of the globus pallidus (GP) are sometimes incidentally observed in patients without a known history of diseases that present with such lesions. The purpose of this study was to evaluate the frequency of this finding and the association between this finding and age, lifestyle diseases and GP calcification.

Methods: We retrospectively investigated the brain magnetic resonance imaging (MRI) of 742 patients, which included between 104 and 108 consecutive patients from each decade of life between the 20s and 80s. The signal intensity ratio of the medial part to the lateral part of the GP in T2-weighted images (T2 medial/lateral ratio) was evaluated. For cases in which brain computed tomography images were available (=437), GP calcifications were also evaluated. The associations between the T2 medial/lateral ratio and age, sex, history of lifestyle diseases and GP calcification were investigated.

Results: Bilateral T2 medial/lateral ratios >1.10, 1.30 and 1.50 were observed in 29.8%, 7.1% and 1.8% of all cases, respectively. A high bilateral T2 medial/lateral ratio was observed less frequently in young patients (<0.01), more frequently in elderly patients and those with hypertension or dyslipidaemia (<0.05) and more frequently in patients with a calcified GP (<0.01).

Conclusion: Incidental bilateral T2 hyperintensities in the medial part of the GP on brain MRI are most likely an age-related physiological finding.
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http://dx.doi.org/10.1177/19714009211014129DOI Listing
May 2021

Axillary lymph node recurrence in patients with breast cancer who underwent breast reconstruction using a latissimus dorsi flap after mastectomy.

Mol Clin Oncol 2021 Mar 19;14(3):49. Epub 2021 Jan 19.

Department of Specialized Surgery, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Tokyo 113-8519, Japan.

At our institution (Tokyo Medical and Dental University, Medical Hospital), latissimus dorsi flap (LD flap) reconstruction without a prosthetic implant is a popular surgical strategy following total mastectomy in patients with breast cancer. The LD flap, especially the extended LD flap, is usually rotated anteriorly through the axilla. However, if future additional surgery is required for axillary recurrence after LD flap reconstruction, the flap interferes with the visual field, making the surgical procedure more difficult. Because cases of axillary lymph node recurrence alone are rare, to the best of our knowledge, no paper has reported in detail on the technique and course of lymph node recurrence after LD flap reconstruction. The present study describes two cases of successful axillary lymph node dissection without sacrificing the flap for breast cancer recurrence after LD flap reconstruction. A brief analysis of immediate breast reconstruction with an LD flap performed in patients with breast cancer at our institution is also reported.
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http://dx.doi.org/10.3892/mco.2021.2211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849059PMC
March 2021

Investigating the Image Quality and Utility of Synthetic MRI in the Breast.

Magn Reson Med Sci 2021 Feb 2. Epub 2021 Feb 2.

Department of Diagnostic Radiology, Tokyo Medical and Dental University.

Purpose: Synthetic MRI reconstructs multiple sequences in a single acquisition. In the present study, we aimed to compare the image quality and utility of synthetic MRI with that of conventional MRI in the breast.

Methods: We retrospectively collected the imaging data of 37 women (mean age: 55.1 years; range: 20-78 years) who had undergone both synthetic and conventional MRI of T2-weighted, T1-weighted, and fat-suppressed (FS)-T2-weighted images. Two independent breast radiologists evaluated the overall image quality, anatomical sharpness, contrast between tissues, image homogeneity, and presence of artifacts of synthetic and conventional MRI on a 5-point scale (5 = very good to 1 = very poor). The interobserver agreement between the radiologists was evaluated using weighted kappa.

Results: For synthetic MRI, the acquisition time was 3 min 28 s. On the 5-point scale evaluation of overall image quality, although the scores of synthetic FS-T2-weighted images (4.01 ± 0.56) were lower than that of conventional images (4.95 ± 0.23; P < 0.001), the scores of synthetic T1- and T2-weighted images (4.95 ± 0.23 and 4.97 ± 0.16) were comparable with those of conventional images (4.92 ± 0.27 and 4.97 ± 0.16; P = 0.484 and 1.000, respectively). The kappa coefficient of conventional MRI was fair (0.53; P < 0.001), and that of conventional MRI was fair (0.46; P < 0.001).

Conclusion: The image quality of synthetic T1- and T2-weighted images was similar to that of conventional images and diagnostically acceptable, whereas the quality of synthetic T2-weighted FS images was inferior to conventional images. Although synthetic MRI images of the breast have the potential to provide efficient image diagnosis, further validation and improvement are required for clinical application.
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http://dx.doi.org/10.2463/mrms.mp.2020-0132DOI Listing
February 2021

Peritoneal dissemination of breast cancer diagnosed by laparoscopy.

Int Cancer Conf J 2021 Jan 14;10(1):91-94. Epub 2020 Nov 14.

Department of Breast Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyou-ku, Tokyo, 113-8519 Japan.

The accuracy of modern imaging techniques for the diagnosis of peritoneal carcinomatosis is poor. A breast cancer patient with a high serum CA15-3 level did not receive a definitive diagnosis of peritoneal dissemination by imaging examination and then underwent laparoscopy. Pathological examination showed peritoneal dissemination of breast cancer, but the biological markers were different from the primary lesion: ER(-), PgR(-), and Her2:3 +. T-DM1 therapy was very effective, and her systemic symptoms disappeared. Since biomarkers of metastatic lesions may sometimes change, laparoscopic biopsy is very important and useful.
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http://dx.doi.org/10.1007/s13691-020-00456-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797395PMC
January 2021

Crohn disease: magnetic resonance enterocolonography features of endoscopic ulcer stages reclassified with the healing process and the relationships to prognoses.

Jpn J Radiol 2021 May 13;39(5):459-476. Epub 2021 Jan 13.

Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: This study aimed to compare magnetic resonance enterocolonography (MREC) features among the endoscopic ulcer stages reclassified to include healing ulcers and to assess the prognoses in Crohn disease (CD).

Methods: Altogether, 89 consecutive patients with CD who had undergone MREC and ileocolonoscopy or balloon-assisted enteroscopy were retrospectively studied. Patients were reclassified into 38 patients with no deep ulcer, seven with healing deep ulcer, and 44 with active deep ulcer stage. MREC score derived from a 5-point MR classification and MR index of activity (MaRIA) were evaluated, and patients were followed-up. The primary endpoint was hospitalization.

Results: Healing deep ulcers had higher values in MREC score and MaRIA than no deep ulcers (p < 0.001), and lower values than active deep ulcers (p < 0.001). The 5-year cumulative rates of hospitalization for no deep ulcer, healing deep ulcer, and active deep ulcers were 24.9, 0, and 52.4% (p < 0.05), respectively. MREC score or MaRIA-positive patients had a higher 5-year cumulative rate of hospitalization than the negative patients (p < 0.01 and p < 0.05, respectively).

Conclusion: MREC could reflect the healing stages, and the identification was revealed to be important because of the good prognosis. MREC might be useful to predict prognosis of CD.
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http://dx.doi.org/10.1007/s11604-020-01082-5DOI Listing
May 2021

Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection.

Eur J Radiol Open 2020 9;7:100289. Epub 2020 Dec 9.

Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan.

Objective: To determine the phase that facilitates flap observation of the ascending aorta in Stanford type A acute aortic dissection with perfused false lumen.

Methods: We reconstructed retrospective Electrocardiogram-gated Computed Tomography Angiography images of the ascending aorta of all 20 patients to 20 phases of curved-multiplanar reconstruction in 5% increment. One radiologist created and randomized 10 cross-sectional images of each phase for every patient and two radiologists scored these images on a 5-point scale depending on the degree of flap stoppage. We calculated the average score for each phase of each case and compared them among the three groups.

Results: Image scores were significantly better in the 65 %-100 % R-R interval group than those in the 5%-30 % (p < 2e-16) and 35 %-60 % R-R interval groups(p = 7.2e-10). Similar scores were observed in the Heart Rate > 70 group (p = 0.00039, 2.2e-14). Moreover a similar tendency was observed in the arrhythmia group (p = 0.0035, 0.294). No difference was found in the degree of flap stoppage in the 65 %-100 % R-R interval group between the Heart Rate > 70 and Heart Rate ≤ 70 groups (p = 0.466) and between the arrhythmia and non-arrhythmia groups (p = 0.1240).

Conclusion: In observing the ascending aorta, We obtained a good image at 65 %-100 % R-R interval and similar tendency was observed in the patients with arrhythmia.
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http://dx.doi.org/10.1016/j.ejro.2020.100289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726336PMC
December 2020

The Utility of Deep Learning in Breast Ultrasonic Imaging: A Review.

Diagnostics (Basel) 2020 Dec 6;10(12). Epub 2020 Dec 6.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

Breast cancer is the most frequently diagnosed cancer in women; it poses a serious threat to women's health. Thus, early detection and proper treatment can improve patient prognosis. Breast ultrasound is one of the most commonly used modalities for diagnosing and detecting breast cancer in clinical practice. Deep learning technology has made significant progress in data extraction and analysis for medical images in recent years. Therefore, the use of deep learning for breast ultrasonic imaging in clinical practice is extremely important, as it saves time, reduces radiologist fatigue, and compensates for a lack of experience and skills in some cases. This review article discusses the basic technical knowledge and algorithms of deep learning for breast ultrasound and the application of deep learning technology in image classification, object detection, segmentation, and image synthesis. Finally, we discuss the current issues and future perspectives of deep learning technology in breast ultrasound.
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http://dx.doi.org/10.3390/diagnostics10121055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762151PMC
December 2020

Association between skin flap necrosis and sarcopenia in patients who underwent total mastectomy.

Asian J Surg 2021 Feb 20;44(2):465-470. Epub 2020 Nov 20.

Department of Specialized Surgeries, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Background: Sarcopenia is associated with postoperative complications in patients undergoing digestive surgery. In this study, we investigated the impact of preoperative sarcopenia on postoperative complications in breast cancer patients who underwent total mastectomy.

Methods: Patients with breast cancer who underwent total mastectomy were included in the analysis. The relationship between the presence of sarcopenia and postoperative complications (e.g., skin flap necrosis and seroma) and between the incidence of these complications as well as preoperative and surgical factors was investigated. Moreover, the effects of sarcopenia on recurrence-free survival and overall survival were evaluated. The psoas muscle index calculated using values measured on preoperative computed tomography images was used to diagnose sarcopenia.

Results: In total, 43 (49%) of 88 patients presented with sarcopenia. The number of patients with a Geriatric Nutritional Risk Index score <91 was higher in the sarcopenia group than in the non-sarcopenia group (p = 0.011). Seroma was observed in 32 (36.4%) patients, and no significant difference was observed between the patients with and without sarcopenia (16 [35.6%] in the non-sarcopenia group vs 16 [37.2%] in the sarcopenia group). By contrast, skin flap necrosis was observed in 20 (22.7%) patients, and the number of patients with this complication was higher in the sarcopenia group than in the non-sarcopenia group (15 [34.9%] vs 5 [11.1%]).

Conclusion: Sarcopenia is a risk factor for skin flap necrosis and may be an important factor for preoperative evaluation in patients who will undergo total mastectomy.
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http://dx.doi.org/10.1016/j.asjsur.2020.11.001DOI Listing
February 2021

High b-value computed diffusion-weighted imaging for differentiating bowel inflammation in Crohn's disease.

Eur J Radiol 2020 Dec 21;133:109362. Epub 2020 Oct 21.

Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

Purpose This study evaluated whether high b-value computed diffusion-weighted imaging (cDWI) can improve detection and differentiation of bowel inflammation in patients with Crohn's disease (CD). Methods Fifty-four consecutive CD patients who had undergone magnetic resonance enterography (MRE) and ileocolonoscopy (ICS) or balloon-assisted enteroscopy (BAE) were retrospectively studied; cDWI with a b-value = 1500s/mm (cDWI1500) was generated using DWI acquired with b-values of 0 and 800 s/mm (aDWI800). Overall, 366 bowel segments were evaluated. The signal intensities (SIs) of the bowel lumina were visually assessed on DWI. Bowel wall-to-iliopsoas muscle SI ratios on aDWI800 and cDWI1500 images and apparent diffusion coefficient (ADC) values were measured; visual assessments for lesion detection were performed using a 5-point Likert-like scale on plain MRE with aDWI800, plain MRE with cDWI1500, and contrast-enhanced (CE)-MRE without DWI. The area under the receiver-operating characteristic curve (AUC) was calculated to compare quantitative and qualitative assessments. Results SIs of the intraluminal fluid were shown as comparable to, or lower than background SIs on 157 (44.7 %) and 345 (98.3 %) of 351 segments on aDWI800 and cDWI1500, respectively. AUCs of SI ratios on cDWI1500 images (82.0 %, [95 % confidence interval: 76.6-87.3 %]) were greater than on aDWI800 (75.2 %, [68.2-82.3 %]; p < 0.001), and were close to the ADC values (81.5 % [76.3-86.7 %]; p = 0.76). The AUCs of CE-MRE images were largest, followed by plain MRE with cDWI1500, and plain MRE with aDWI800. Conclusions As it suppresses the SIs of intraluminal fluid and improves contrast between severe and non-severe inflammation, cDWI1500 helps with CD evaluation.
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http://dx.doi.org/10.1016/j.ejrad.2020.109362DOI Listing
December 2020

Deep-learning approach with convolutional neural network for classification of maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging.

Magn Reson Imaging 2021 01 10;75:1-8. Epub 2020 Oct 10.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: We aimed to evaluate deep learning approach with convolutional neural networks (CNNs) to discriminate between benign and malignant lesions on maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging (MRI).

Methods: We retrospectively gathered maximum intensity projections of dynamic contrast-enhanced breast MRI of 106 benign (including 22 normal) and 180 malignant cases for training and validation data. CNN models were constructed to calculate the probability of malignancy using CNN architectures (DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, NasNetMobile, and Xception) with 500 epochs and analyzed that of 25 benign (including 12 normal) and 47 malignant cases for test data. Two human readers also interpreted these test data and scored the probability of malignancy for each case using Breast Imaging Reporting and Data System. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated.

Results: The CNN models showed a mean AUC of 0.830 (range, 0.750-0.895). The best model was InceptionResNetV2. This model, Reader 1, and Reader 2 had sensitivities of 74.5%, 72.3%, and 78.7%; specificities of 96.0%, 88.0%, and 80.0%; and AUCs of 0.895, 0.823, and 0.849, respectively. No significant difference arose between the CNN models and human readers (p > 0.125).

Conclusion: Our CNN models showed comparable diagnostic performance in differentiating between benign and malignant lesions to human readers on maximum intensity projection of dynamic contrast-enhanced breast MRI.
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http://dx.doi.org/10.1016/j.mri.2020.10.003DOI Listing
January 2021

Late-onset pneumothorax in a COVID-19 patient treated with ventilation and ECMO: A case report and literature review.

Radiol Case Rep 2020 Dec 23;15(12):2560-2564. Epub 2020 Sep 23.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113 - 8510, Tokyo, Japan.

Coronavirus disease 2019 (COVID-19) has become a major threat to public health since the outbreak in Wuhan in 2019. Chest computed tomography is recommended for COVID-19 cases for evaluation and follow up of pneumonia and related complication. We report the case of a 66-year-old man with underlying hypertension and a history of smoking 76 packs a year; he was frequently monitored by computed tomography for pulmonary changes during the period from early symptom onset to death. Furthermore, he developed a pneumothorax during the course. The occurrence of pneumothorax in COVID-19 patients is not common, and there have been only a few previous reports. This is a valuable case of pneumothorax in a patient with COVID-19 treated with a ventilator and extracorporeal membrane oxygenation. This case and previous reports suggest that pneumothorax occurs in COVID-19 with a relatively late onset (3-8 weeks). Long-term pneumonia morbidity, steroid therapy, positive pressure ventilation, and extracorporeal membrane oxygenation can cause pneumothorax, leading to capillary and alveolar damage.
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http://dx.doi.org/10.1016/j.radcr.2020.09.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510434PMC
December 2020

Feasibility of ultrafast dynamic magnetic resonance imaging for the diagnosis of axillary lymph node metastasis: A case report.

Eur J Radiol Open 2020 3;7:100261. Epub 2020 Sep 3.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113 - 8510, Japan.

A 74 year old Japanese woman was diagnosed with invasive breast carcinoma. Her axillary lymph node was slightly swollen and had a short-axis diameter of 8 mm, but fine-needle aspiration did not lead to the diagnosis of metastasis. Subsequent 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed no abnormal accumulation on the lymph node. Ultrafast dynamic magnetic resonance imaging yielded a very fast contrast enhancement like that of the primary lesion based on which we suspected lymph node metastasis. To our knowledge, this is the first report that shows that ultrafast imaging has contributed to the diagnosis of axillary lymph node metastasis.
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http://dx.doi.org/10.1016/j.ejro.2020.100261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481530PMC
September 2020

Evaluation of the Usefulness of CO-RADS for Chest CT in Patients Suspected of Having COVID-19.

Diagnostics (Basel) 2020 Aug 19;10(9). Epub 2020 Aug 19.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

The purpose of this study was to use the Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) to evaluate the chest computed tomography (CT) images of patients suspected of having COVID-19, and to investigate its diagnostic performance and interobserver agreement. The Dutch Radiological Society developed CO-RADS as a diagnostic indicator for assessing suspicion of lung involvement of COVID-19 on a scale of 1 (very low) to 5 (very high). We investigated retrospectively 154 adult patients with clinically suspected COVID-19, between April and June 2020, who underwent chest CT and reverse transcription-polymerase chain reaction (RT-PCR). The patients' average age was 61.3 years (range, 21-93), 101 were male, and 76 were RT-PCR positive. Using CO-RADS, four radiologists evaluated the chest CT images. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Interobserver agreement was calculated using the intraclass correlation coefficient (ICC) by comparing the individual reader's score to the median of the remaining three radiologists. The average sensitivity was 87.8% (range, 80.2-93.4%), specificity was 66.4% (range, 51.3-84.5%), and AUC was 0.859 (range, 0.847-0.881); there was no significant difference between the readers ( > 0.200). In 325 (52.8%) of 616 observations, there was absolute agreement among observers. The average ICC of readers was 0.840 (range, 0.800-0.874; < 0.001). CO-RADS is a categorical taxonomic evaluation scheme for COVID-19 pneumonia, using chest CT images, that provides outstanding performance and from substantial to almost perfect interobserver agreement for predicting COVID-19.
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http://dx.doi.org/10.3390/diagnostics10090608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555303PMC
August 2020

Efficient Anomaly Detection with Generative Adversarial Network for Breast Ultrasound Imaging.

Diagnostics (Basel) 2020 Jul 4;10(7). Epub 2020 Jul 4.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

We aimed to use generative adversarial network (GAN)-based anomaly detection to diagnose images of normal tissue, benign masses, or malignant masses on breast ultrasound. We retrospectively collected 531 normal breast ultrasound images from 69 patients. Data augmentation was performed and 6372 (531 × 12) images were available for training. Efficient GAN-based anomaly detection was used to construct a computational model to detect anomalous lesions in images and calculate abnormalities as an anomaly score. Images of 51 normal tissues, 48 benign masses, and 72 malignant masses were analyzed for the test data. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of this anomaly detection model were calculated. Malignant masses had significantly higher anomaly scores than benign masses ( < 0.001), and benign masses had significantly higher scores than normal tissues ( < 0.001). Our anomaly detection model had high sensitivities, specificities, and AUC values for distinguishing normal tissues from benign and malignant masses, with even greater values for distinguishing normal tissues from malignant masses. GAN-based anomaly detection shows high performance for the detection and diagnosis of anomalous lesions in breast ultrasound images.
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http://dx.doi.org/10.3390/diagnostics10070456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400007PMC
July 2020

Feasibility of new fat suppression for breast MRI using pix2pix.

Jpn J Radiol 2020 Nov 1;38(11):1075-1081. Epub 2020 Jul 1.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: To generate and evaluate fat-saturated T1-weighted (FST1W) image synthesis of breast magnetic resonance imaging (MRI) using pix2pix.

Materials And Methods: We collected pairs of noncontrast-enhanced T1-weighted an FST1W images of breast MRI for training data (2112 pairs from 15 patients), validation data (428 pairs from three patients), and test data (90 pairs from 30 patients). From the original images, 90 synthetic images were generated with 50, 100, and 200 epochs using pix2pix. Two breast radiologists evaluated the synthetic images (from 1 = excellent to 5 = very poor) for quality of fat suppression, anatomic structures, artifacts, etc. The average score was analyzed for each epoch and breast density.

Results: The synthetic images were scored from 2.95 to 3.60; the best was reduction in artifacts when using 100 epochs. The average overall quality scores for fat suppression were 3.63 at 50 epochs, 3.24 at 100 epochs, and 3.12 at 200 epochs. In the analysis for breast density, each score was significantly better for nondense breasts than for dense breasts; the average score was 2.88-3.18 for nondense breasts and 3.03-3.42 for dense breasts (P = 0.000-0.042).

Conclusion: Pix2pix had the potential to generate FST1W synthesis for breast MRI.
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http://dx.doi.org/10.1007/s11604-020-01012-5DOI Listing
November 2020

Virtual Interpolation Images of Tumor Development and Growth on Breast Ultrasound Image Synthesis With Deep Convolutional Generative Adversarial Networks.

J Ultrasound Med 2021 Jan 27;40(1):61-69. Epub 2020 Jun 27.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: We sought to generate realistic synthetic breast ultrasound images and express virtual interpolation images of tumors using a deep convolutional generative adversarial network (DCGAN).

Methods: After retrospective selection of breast ultrasound images of 528 benign masses, 529 malignant masses, and 583 normal breasts, 20 synthesized images of each were generated by the DCGAN. Fifteen virtual interpolation images of tumors were generated by changing the value of the input vector. A total of 60 synthesized images and 20 virtual interpolation images were evaluated by 2 readers, who scored them on a 5-point scale (1, very good; to 5, very poor) and then answered whether the synthesized image was benign, malignant, or normal.

Results: The mean score of overall quality for synthesized images was 3.05, and that of the reality of virtual interpolation images was 2.53. The readers classified the generated images with a correct answer rate of 92.5%.

Conclusions: A DCGAN can generate high-quality synthetic breast ultrasound images of each pathologic tissue and has the potential to create realistic virtual interpolation images of tumor development.
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http://dx.doi.org/10.1002/jum.15376DOI Listing
January 2021

Classification of Breast Masses on Ultrasound Shear Wave Elastography using Convolutional Neural Networks.

Ultrason Imaging 2020 Jul-Sep;42(4-5):213-220. Epub 2020 Jun 5.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

We aimed to use deep learning with convolutional neural networks (CNNs) to discriminate images of benign and malignant breast masses on ultrasound shear wave elastography (SWE). We retrospectively gathered 158 images of benign masses and 146 images of malignant masses as training data for SWE. A deep learning model was constructed using several CNN architectures (Xception, InceptionV3, InceptionResNetV2, DenseNet121, DenseNet169, and NASNetMobile) with 50, 100, and 200 epochs. We analyzed SWE images of 38 benign masses and 35 malignant masses as test data. Two radiologists interpreted these test data through a consensus reading using a 5-point visual color assessment (SWEc) and the mean elasticity value (in kPa) (SWEe). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. The best CNN model (which was DenseNet169 with 100 epochs), SWEc, and SWEe had a sensitivity of 0.857, 0.829, and 0.914 and a specificity of 0.789, 0.737, and 0.763 respectively. The CNNs exhibited a mean AUC of 0.870 (range, 0.844-0.898), and SWEc and SWEe had an AUC of 0.821 and 0.855. The CNNs had an equal or better diagnostic performance compared with radiologist readings. DenseNet169 with 100 epochs, Xception with 50 epochs, and Xception with 100 epochs had a better diagnostic performance compared with SWEc ( = 0.018-0.037). Deep learning with CNNs exhibited equal or higher AUC compared with radiologists when discriminating benign from malignant breast masses on ultrasound SWE.
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http://dx.doi.org/10.1177/0161734620932609DOI Listing
June 2020

Predictors for upstaging of ductal carcinoma (DCIS) to invasive carcinoma in non-mass-type DCIS.

Mol Clin Oncol 2020 Jul 27;13(1):67-72. Epub 2020 Apr 27.

Department of Surgical Specialties, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Bunkyo-ku, Tokyo 113-8519, Japan.

Preoperatively diagnosed ductal carcinoma (DCIS) is sometimes upstaged to invasive cancer by postoperative pathological examination. Various preoperative factors associated with upstaging to invasive cancer have been reported; however, this subject remains to be clarified. DCIS takes various forms on imaging, but many cases show non-mass-type lesions. In non-mass-type DCIS, recognizing the presence of invasion is difficult. To investigate predictors associated with upstaging to invasive cancer more precisely, we examined only non-mass-type DCIS. The present study retrospectively analyzed 101 patients diagnosed with non-mass-type DCIS preoperatively on breast biopsy at our institution between 2007 and 2017. Data were analyzed using Fisher's exact probability test and two-sample t-tests. Multivariate analysis was performed using logistic regression. The results showed that 27 patients (27%) were finally diagnosed with invasive cancer. Univariate analysis revealed abnormal result of palpation on breast examination (P=0.05), comedo necrosis (P=0.05), and HER2 status (P=0.02) as significant predictors. Multivariate analysis revealed an abnormal result of palpation as an independent predictor of invasive cancer underestimation (odds ratio 4.76; confidence interval 1.44-15.7; P=0.01). In conclusion, preoperatively diagnosed non-mass-type DCIS represented an underestimation in approximately 27% of cases. In particular, the presence of a clinically abnormal palpation increases the chance of upstaging to invasive cancer.
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http://dx.doi.org/10.3892/mco.2020.2036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243301PMC
July 2020

Detection and Diagnosis of Breast Cancer Using Artificial Intelligence Based assessment of Maximum Intensity Projection Dynamic Contrast-Enhanced Magnetic Resonance Images.

Diagnostics (Basel) 2020 May 20;10(5). Epub 2020 May 20.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

We aimed to evaluate an artificial intelligence (AI) system that can detect and diagnose lesions of maximum intensity projection (MIP) in dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI). We retrospectively gathered MIPs of DCE breast MRI for training and validation data from 30 and 7 normal individuals, 49 and 20 benign cases, and 135 and 45 malignant cases, respectively. Breast lesions were indicated with a bounding box and labeled as benign or malignant by a radiologist, while the AI system was trained to detect and calculate possibilities of malignancy using RetinaNet. The AI system was analyzed using test sets of 13 normal, 20 benign, and 52 malignant cases. Four human readers also scored these test data with and without the assistance of the AI system for the possibility of a malignancy in each breast. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.926, 0.828, and 0.925 for the AI system; 0.847, 0.841, and 0.884 for human readers without AI; and 0.889, 0.823, and 0.899 for human readers with AI using a cutoff value of 2%, respectively. The AI system showed better diagnostic performance compared to the human readers ( = 0.002), and because of the increased performance of human readers with the assistance of the AI system, the AUC of human readers was significantly higher with than without the AI system ( = 0.039). Our AI system showed a high performance ability in detecting and diagnosing lesions in MIPs of DCE breast MRI and increased the diagnostic performance of human readers.
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http://dx.doi.org/10.3390/diagnostics10050330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277981PMC
May 2020

[A Case of Axillary Accessory Breast Cancer Treated via Latissimus Dorsi Musculocutaneous Flap Reconstruction].

Gan To Kagaku Ryoho 2020 Feb;47(2):343-345

Dept. of Breast Surgery, Tokyo Medical and Dental University.

A 46-year-old woman visited our hospital with the chief complaint of left axillary mass enlargement, which she had been aware of for 8 years. Palpation revealed that the mass was 15mm in size. Redness and gathering of the skin were also observed. Mammographic imaging of the left axilla revealed an irregular mass with skin infiltration. Breast ultrasonography revealed a low echo mass in the left axilla, which was continuous from the skin. Core needle biopsy was used to diagnose the tumor as an invasive ductal carcinoma. No other lesions were observed in the breast, and primary lesions were not found in any other organs. The patient was diagnosed with axillary accessory breast cancer and underwent local extensive resection and axillary lymph node dissection. Because the skin defect was widespread, we performed axillary reconstruction using the latissimus dorsi musculocutaneous flap to prevent upper limb contracture. At present, she can move her upper limbs and lymphedema has not been observed. In cases of axillary accessory breast cancer with skin infiltration, reconstruction using the latissimus dorsi musculocutaneous flap can be a useful procedure.
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February 2020

[A Case of Breast Cancer Complicated with Castleman's Disease].

Gan To Kagaku Ryoho 2019 Dec;46(13):2455-2457

Dept. of Specialized Surgeries, Tokyo Medical and Dental University Graduate School.

The patient was a 57-year-old woman with Castleman's disease. The follow-up CT scans obtained during the treatment of Castleman's disease, detected a 15mm nodule in the right breast AC area, and the patient was diagnosed with breast cancer. Lymphadenopathy was noted on both sides of the axilla; however, it was considered to be due to Catsleman's disease. Mastectomy and sentinel lymph node biopsy were performed with preoperative diagnosis of cT1cN0M0, cStage Ⅰ. Rapid diagnosis of the sentinel lymph node during the operation showed a metastatic tumor measuring 3mm and axillary dissection was performed. However, no metastasis was found in the dissected lymph node, which was, therefore, considered as an enlargement due to Castleman's disease.
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December 2019

Breast Ultrasound Image Synthesis using Deep Convolutional Generative Adversarial Networks.

Diagnostics (Basel) 2019 Nov 6;9(4). Epub 2019 Nov 6.

Department of Diagnostic Radiology, Tokyo Medical and Dental University Hospital 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8501, Japan.

Deep convolutional generative adversarial networks (DCGANs) are newly developed tools for generating synthesized images. To determine the clinical utility of synthesized images, we generated breast ultrasound images and assessed their quality and clinical value. After retrospectively collecting 528 images of 144 benign masses and 529 images of 216 malignant masses in the breasts, synthesized images were generated using a DCGAN with 50, 100, 200, 500, and 1000 epochs. The synthesized ( = 20) and original ( = 40) images were evaluated by two radiologists, who scored them for overall quality, definition of anatomic structures, and visualization of the masses on a five-point scale. They also scored the possibility of images being original. Although there was no significant difference between the images synthesized with 1000 and 500 epochs, the latter were evaluated as being of higher quality than all other images. Moreover, 2.5%, 0%, 12.5%, 37.5%, and 22.5% of the images synthesized with 50, 100, 200, 500, and 1000 epochs, respectively, and 14% of the original images were indistinguishable from one another. Interobserver agreement was very good (|| = 0.708-0.825, < 0.001). Therefore, DCGAN can generate high-quality and realistic synthesized breast ultrasound images that are indistinguishable from the original images.
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http://dx.doi.org/10.3390/diagnostics9040176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963542PMC
November 2019

Diagnostic performance of time-of-flight PET/CT for evaluating nodal metastasis of the axilla in breast cancer.

Nucl Med Commun 2019 Sep;40(9):958-964

Departments of Diagnostic Radiology.

Objective: The aim of this study was to evaluate the performance of preoperative axillary lymph node assessment in breast cancer using time-of-flight 18F-fluorodeoxyglucose PET/computed tomography (TOF [F-18]FDG-PET/CT).

Methods: Eighty-two women with breast cancer (mean age, 59.3 years; range, 30-84 years) underwent TOF [F-18]FDG-PET/CT scanning before surgery between January 2016 and June 2018 at our hospital. Visual analysis of FDG uptake and the maximum standardized uptake value (SUVmax) of axillary lymph nodes were compared with the pathological diagnoses.

Results: There were 77 patients with invasive breast carcinoma (mean invasive long diameter, 18.5 mm; range, 2-90 mm) and five patients with noninvasive carcinoma. Axillary lymph node metastases were histologically confirmed in 13 of 82 patients (15.9%). SUVmax showed an area under a receiver operating characteristic curve of 0.916, and the cut-off value of 1.1 was appropriate. By visual assessment, there were 11 true positives, 15 false positives, 54 true negatives and two false negatives; the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85%, 78%, 42%, 96% and 79%, respectively. SUVmax showed values of 69%, 99%, 90%, 94% and 94%, respectively.

Conclusions: The sensitivity of TOF [F-18]FDG-PET/CT was as high as 85% by visual analysis. SUVmax using TOF [F-18]FDG-PET/CT showed high diagnostic performance for N-staging in breast cancer patients, especially high negative predictive value. The specificity, positive predictive value and accuracy of SUVmax were higher than those of visual analysis.
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http://dx.doi.org/10.1097/MNM.0000000000001057DOI Listing
September 2019

Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments.

Breast Cancer 2019 Nov 7;26(6):792-798. Epub 2019 Jun 7.

Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: To compare the addition of diagnostic strain elastography (SE) and shear wave elastography (SWE) values to the conventional B-mode ultrasonography in differentiating between benign and malignant breast masses by qualitative and quantitative assessments.

Materials And Methods: B-mode ultrasound, SE, and SWE were simultaneously performed using one ultrasound system in 148 breast masses; 88 of them were malignant. The breast imaging reporting and data system category in the B-mode, Tsukuba score (SE), Fat-Lesion-Ratio (SE) in SE, and five-point color assessment (SWE) and elasticity values (SWE) in SWE were assessed. The results were compared using the area under the receiver-operating characteristic curve (AUC).

Result: The AUC for B-mode and each elastography were similar (B-mode, 0.889; SE, 0.885; SE, 0.875; SWE, 0.881; SWE, 0.885; P > 0.05). The combined sets between B-mode and either of the elastography technique showed good diagnostic performance (B-mode + SE, 0.903; B-mode + SE, 0.909; B-mode + SWE, 0.919; B-mode + SWE, 0.914). B-mode + SWE and B-mode + SWE showed a higher AUC than B-mode alone (P = 0.026 and 0.029), and B-mode + SE and B-mode + SE showed comparable AUC to B-mode alone (P = 0.196 and 0.085). There was no significant difference between qualitative and quantitative assessments for the combined sets of B-mode and elastography (P > 0.05).

Conclusion: The addition of both SE and SWE to B-mode ultrasound improved the diagnostic performance with increased AUC, and especially SWE was more useful than SE, and no significant difference was found between qualitative and quantitative assessments.
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http://dx.doi.org/10.1007/s12282-019-00985-0DOI Listing
November 2019
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