Dual-energy computed tomography for evaluation of breast cancer: value of virtual monoenergetic images reconstructed with a noise-reduced monoenergetic reconstruction algorithm

Okada, Kanako; Matsuda, Megumi; Tsuda, Toshihide; Kido, Teruhiko; Murata, Akira; Nishiyama, Hiroki; Nishiyama, Kanako; Yamasawa, Haruna; Kamei, Yasuhiro; Kurata, Mie; Fukushima, Mana; Kitazawa, Riko; Mochizuki, Takashi

doi:10.1007/s11604-019-00897-1

Cited by 18 publications

(20 citation statements)

References 51 publications

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“…Recently, DECT has attracted wide research interest for use in the differentiation of benign from malignant tumors, as well as histopathological and genotypic classification (12)(13)(14)(15)(16)(17). So far, only a few studies (18)(19)(20)(21) have evaluated breast lesion visibility by reconstructing images from DECT. A small-sample study (22) demonstrated that the iodine concentration was higher in invasive non-special carcinoma than in DCIS and benign tumors.…”

Section: Introductionmentioning

confidence: 99%

Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer

Wang¹,

Liu²,

Zeng³

et al. 2021

Quant Imaging Med Surg

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Background: Dual-energy computed tomography (DECT) is widely used to characterize and differentiate tumors. However, data regarding its diagnostic performance for the characterization of breast tumors are limited. In this study, we assessed the diagnostic performance of quantitative parameters derived from DECT in differentiating benign from malignant lesions and predicting histopathological and molecular subtypes in patients with breast cancer.Methods: Dual-phase contrast-enhanced DECT of the thorax was performed on participants with breast tumors. Conventional CT attenuation and DECT quantitative parameters, including normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λ Hu ), and normalized effective atomic number (nZ eff ), were obtained and compared between benign and malignant lesions, invasive nonspecial carcinoma, and ductal carcinoma in situ (DCIS), and among the four molecular subtypes of breast cancer. The diagnostic performance of the quantitative parameters was analyzed using receiver operating characteristic (ROC) curves.Results: This study included 130 participants with 161 breast lesions (44 benign and 117 malignant). In the arterial and venous phase, NICs, λ Hu , nZ eff , and attenuation were higher in malignant lesions than benign lesions (all P<0.001). The venous phase λ Hu had the best differential diagnostic capability, with an area under the curve (AUC) of 0.90, a sensitivity of 84.1% (37 of 44), a specificity of 86.3% (101 of 117), and an accuracy of 85.7% (138 of 161). The NICs in the arterial and venous phases were higher in invasive nonspecial carcinoma than DCIS (both P<0.001). In terms of diagnostic performance, NIC in the venous phase had an AUC of 0.77, a sensitivity of 75.0% (12 of 16), a specificity of 81.2% (82 of 101), and an accuracy of 80.3% (94 of 117). The luminal A subtype produced a lower venous phase NIC, and arterial and venous phase nZ eff than the non-luminal A subtype (AUC of 0.91 for the combination of these three parameters).Conclusions: Dual-energy CT quantitative parameters are a feasible and valuable noninvasive means of differentiating between benign and malignant lesions, and predicting histopathological and molecular subtypes in patients with breast cancer.

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Section: Introductionmentioning

confidence: 99%

Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer

Wang¹,

Liu²,

Zeng³

et al. 2021

Quant Imaging Med Surg

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“…Chest CT, used for the evaluation of potential lung metastasis or concomitant pulmonary disease (4), is unable to precisely characterize primary breast tumors (5) because of its relatively low soft tissue resolution. Recently, a noiseoptimized virtual monoenergetic image reconstruction algorithm [MEI (+)] was developed, which has been shown to improve the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) in oncological imaging (6)(7)(8). Although dual-energy CT (DECT) has proven feasibility in the imaging of primary breast cancers (9), the use of more reconstruction images, such as iodine density (ID) maps (10), iodine overlay (IO) images, and Z effective (Zeff) maps (11), as well as polyenergetic images (PEI) should be considered when investigating lesion conspicuity.…”

Section: Introductionmentioning

confidence: 99%

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

et al. 2021

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Objective To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. Materials and Methods This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff ) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. Results Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion : 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images ( p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI ( p = 0.022, p = 0.033, respectively). Conclusion Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

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“…It can not only evaluate the effective uptake of contrast medium by the lesion but can also characterize tissue using z-analysis. 23 , 24 This technique might have high diagnostic value for EICs with a complex composition.…”

Section: Discussionmentioning

confidence: 99%

Giant epidermal inclusion cyst with infection arising within the breast parenchyma: a case report

et al. 2021

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Epidermal inclusion cysts (EICs) of the breast develop in the deep breast parenchyma, and they are very rare. Only about 10 cases have been reported in the English-language literature to date. In this report, we present a rare case of a giant EIC with infection arising within the deep breast parenchyma. Unlike a typical EIC of the breast, the EIC in the present case was a cystic and solid lesion containing a large amount of liquid within the cyst and popcorn-like calcification in the wall. In this report, we describe the contrast-enhanced spectral mammography (CESM), ultrasonography, and computed tomography findings and provide a reference for the diagnosis of EICs. To the best of our knowledge, this is the first report of the CESM findings of an EIC. Our case illustrates that CESM has excellent performance similar to that of magnetic resonance imaging and is much more effective than conventional digital mammography. Additionally, our case indicates that precise correlation of CESM with ultrasonography findings contributes to the diagnosis of EICs. This rare case with multiple imaging findings will increase the awareness of EICs in the breast parenchyma.

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Dual-energy computed tomography for evaluation of breast cancer: value of virtual monoenergetic images reconstructed with a noise-reduced monoenergetic reconstruction algorithm

Cited by 18 publications

References 51 publications

Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer

Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Giant epidermal inclusion cyst with infection arising within the breast parenchyma: a case report

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