C. Balleyguier

Evaluation of Tumor Angiogenesis of Breast Carcinoma Using Contrast-Enhanced Digital Mammography

OBJECTIVE The purpose of this article is to assess the accuracy of contrast-enhanced digital mammography in the detection of breast carcinoma and to correlate the findings on the images with those of histologic analysis using microvessel quantification. SUBJECTS AND METHODS Twenty patients with a suspicious breast abnormality underwent contrast-enhanced digital mammography using a full-field digital mammography unit that was modified to detect iodinated enhancement. For each patient, a total of six contrast-enhanced craniocaudal views were acquired from 30 seconds to 7 minutes after the injection of a bolus of 100 mL of an iodinated contrast agent. Image processing included a logarithmic subtraction and the analysis of enhancement kinetic curves. Contrast-enhanced digital mammography findings were compared with histologic analysis of surgical specimens, including intratumoral microvessel density quantification evaluated on CD34-immunostained histologic sections obtained from all patients. RESULTS An area of enhancement was depicted on contrast-enhanced digital mammograms in 16 of the 20 histologically proven breast carcinomas. Excellent correlation was seen between the size of enhancement and the histologic size of tumors, which ranged from 9 to 22 mm. Early enhancement with washout was observed in four cases, early enhancement followed by a plateau in four cases, gradual enhancement in seven cases, and unexpected decrease of enhancement in one case. Intratumoral microvessel density ranged from 11.7 to 216.6 microvessels per square millimeter. A poor correlation was found between data measured on contrast-enhanced digital mammography and intratumoral microvessel density measured on CD34-immunostained histologic sections. CONCLUSION Contrast-enhanced digital mammography is able to depict angiogenesis in breast carcinoma. Breast compression and projective images acquisition alter the quantitative assessment of enhancement parameters.

Breast elasticity: principles, technique, results: an update and overview of commercially available software.

Breast ultrasound elasticity evaluation has become a routine tool in addition to diagnostic ultrasound during the last five years. Two elasticity evaluation modes are currently available: free-hand elastography and shear-wave elastography (SWE). Most of the commercially available elastography scanners have specific procedures which must be understood by the users. Free-hand elastography usually displays qualitative imaging such as an elastogram, but most of the companies now use it to quantify the relative stiffness between a lesion and the surrounding breast tissue. SWE is a new mode theoretically independent of the sonographer which displays more quantitative information, and can be useful for characterizing breast lesions. Recent studies on elastography suggest that elasticity imaging can increase B-mode accuracy and specificity in differentiating benign and malignant breast lesions. This functional imaging mode could help reduce the number of biopsies performed for benign breast lesions. This review gives a detailed description of the main commercially available systems and the results of current applications in the evaluation of breast elasticity.

Computed-aided diagnosis (CAD) in the detection of breast cancer

Computer-aided detection (CAD) systems have been developed for interpretation to improve mammographic detection of breast cancer at screening by reducing the number of false-negative interpretation that can be caused by subtle findings, radiologist distraction and complex architecture. They use a digitized mammographic image that can be obtained from both screen-film mammography and full field digital mammography. Its performance in breast cancer detection is dependent on the performance of the CAD itself, the population to which it is applied and the radiologists who use it. There is a clear benefit to the use of CAD in less experienced radiologist and in detecting breast carcinomas presenting as microcalcifications. This review gives a detailed description CAD systems used in mammography and their performance in assistance of reading in screening mammography and as an alternative to double reading. Other CAD systems developed for MRI and ultrasound are also presented and discussed.

Comprendre et utiliser le CAD (Aide informatisée au diagnostic) en mammographie

Resume La generalisation du depistage organise du cancer du sein necessite la mise en place de la double lecture qui permet de reduire le taux de faux negatifs du depistage, mais peut etre d’organisation difficile. Les systemes informatiques d’aide au diagnostic (CAD) sont en amelioration constante et sont capables de detecter des images mammographiques suspectes, foyers de microcalcifications, masses ou distorsion architecturale. Des progres sont aussi enregistres dans la caracterisation des masses par CAD. L’objectif de cette mise au point est de faire l’etat des lieux des differents systemes CAD disponibles actuellement, de decrire leurs principes de fonctionnement et de presenter les principaux resultats du CAD en mammographie. En particulier, la place du CAD dans le depistage organise, selon les resultats des dernieres etudes prospectives publiees sera discutee.

Whole body MRI in paediatric oncology

Whole body MRI provides excellent contrast resolution imaging and is an interesting alternative to nuclear medicine examinations in paediatric oncology because it does not involve exposure to radiation. This technique, now feasible in clinical practice, helps to evaluate metastatic spread and response to treatment, which are of great prognostic interest. Numerous studies have demonstrated the non-inferiority of this technique when compared to nuclear medicine examinations. However, there is still a need to standardize indications in each type of cancer and at every stage of it. This article first discusses the technical principles of whole body MRI, then reviews current clinical applications for the modality in children, and finally, discusses future useful developments for paediatric oncology.

Approche didactique de la moelle osseuse en IRM

The marrow contains a variable amount of yellow or fatty marrow and red or cellular marrow creating the signal intensity observed on MRI. Marrow replacement (by cells not normally present in bone marrow) typically is T1W hypointense. Marrow proliferation (by cells normally present in bone marrow) may be T1W hypointense (pseudo marrow replacement) or show intermediate T1W signal intensity due to red marrow redistribution. Marrow edema (reaction to an external process) show intermediate T1W hypointensity (mixture of water and marrow). Location will allow correct diagnosis. Bone marrow ischemia usually results in a necrotic fragment surrounded by a thin T1W hypointense rim.

Liposarcome du rétropéritoine

Resume Le liposarcome du retroperitoine est relativement frequent. Le role de l’imagerie est principalement de detecter la lesion, mais aussi d’en faire un bilan d’extension tres precis et de rechercher des elements en faveur de la malignite.

Imagerie fonctionnelle du sein

RésuméL’imagerie mammaire connaît depuis quelques années de nouveaux développements. Ces nouvelles méthodes d’imagerie sont principalement orientées sur l’étude fonctionnelle des tumeurs et ont pour objectif d’améliorer la détection et la caractérisation des tumeurs, mais également de fournir de nouveaux critères pronostiques et de guider la thérapeutique des tumeurs mammaires. Une des études fonctionnelles la plus prometteuse que ce soit par ultrasons, par rayons X ou par IRM est l’étude de l’angiogenèse tumorale qui joue un rôle majeur dans le développement des tumeurs et leur potentialité à métastaser. Nous allons présenter dans cet article les principaux développements de l’imagerie fonctionnelle mammaire concernant toutes les méthodes d’imagerie que ce soit les rayons X, l’échographie, l’IRM et la médecine nucléaire. Après un bref rappel technique nous présenterons les premiers résultats cliniques ainsi que les perspectives de chacune de ces techniques.AbstractIn recent years, breast imaging has benefited from a number of new advances. The resulting new imaging methods mainly focus on the functional examination of tumours and aim to improve tumour detection and characterization, provide new prognosis criteria, and guide the therapeutic management of breast cancer. One of the most promising functional assessments — whether performed through the use of ultrasound, X-rays or MRI — is the analysis of tumour angiogenesis, which plays a major role in tumour development and metastatic potential. In this article, we discuss the major developments in functional imaging of the breast, including imaging methods such as X-rays, ultrasound, MRI and nuclear medicine. After a brief technology overview, we present the early clinical results and prospects of each of the techniques.

La génétique constitutionnelle peut-elle impacter la prise en charge d’une femme atteinte de cancer du sein aujourd’hui ?

The concept of personalized medicine has rapidly become a major part of breast cancer care. It relies on complex biological evaluations and predictions of both the prognostic and the specific treatment sensitivity of a single tumor and a single individual. Germline genetics can currently provide information that appears complementary to that provided by somatic analyses, regarding local and general prognosis of the current cancer and also subsequent cancer risk. In the next few years, germline genetic data should also have a major role to play in the evaluation of potential sensitivity to medical treatments (treatments targeting DNA repair such as the recently emerging PARP inhibitors), and therefore guide major treatment choices. This paper summarizes current existing data regarding the potential impact of germline genetics in the personalized care of breast cancer patients in 2010 and the evolutions expected in the coming years.RésuméLe concept de médecine personnalisée s’est fortement développé dans la prise en charge des cancers du sein ces dernières années. Il repose sur des tests biologiques complexes, sur la tumeur évaluant le pronostic et la sensibilité de la maladie aux traitements potentiels. La génétique constitutionnelle est aujourd’hui capable d’apporter des informations essentielles et complémentaires aux données somatiques, en matière de pronostic local et général, mais surtout en termes de risque de nouveau cancer. Dans les années qui viennent, elle sera essentielle pour l’évaluation de la sensibilité potentielle spécifique aux thérapeutiques, en particulier avec l’arrivée de thérapeutiques ciblées spécialisées (les inhibiteurs de poly[ADP-ribose] polymérase [PARP] étant les chefs de file en cas d’anomalies constitutionnelles de réparation de l’ADN par exemple). Dans certains cas très rares, la sensibilité thérapeutique peut être excessive, comme en cas de présence d’une anomalie constitutionnelle de type p53 qui peut contre-indiquer les radiations ionisantes. Cette revue fait le bilan de nos connaissances en matière d’impact de la génétique constitutionnelle dans la prise en charge personnalisée des cancers du sein en 2010 et les modifications attendues dans les années à venir.

ORL-WP-33 Lecture facile des foramens de la base du crane en imagerie

Objectifs pedagogiques Savoir reconnaitre ces foramens (topographie et forme). Faciliter la memorisation de leur contenu. Detecter leur extension de maniere precoce et cibler l’imagerie en cas de symptomatologie localisatrice. Messages a retenir Les foramens ne sont pas accessibles cliniquement, le scanner et l’IRM (surtout) sont necessaires a leur exploration. Les nerfs crâniens ont ete denommes de un a douze au fur et a mesure qu’ils sortent de la base du crâne de haut en bas et d’avant en arriere. Les foramens sont des canaux dont l’axe est soit parallele soit perpendiculaire au palais osseux, facilitant leur exploration en imagerie. L’obturation de la graisse (au scanner en en Tl en IRM) ou la prise de contraste en IRM sont les signes les plus precoces de leur envahissement.