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Nicosia L, Battaglia O, Venturini M, Fontana F, Minenna M, Pesenti A, Budascu D, Pesapane F, Bozzini AC, Pizzamiglio M, Meneghetti L, Latronico A, Signorelli G, Mariano L, Cassano E. Contrast-enhanced mammography BI-RADS: a case-based approach to radiology reporting. Insights Imaging 2024; 15:37. [PMID: 38332410 PMCID: PMC10853105 DOI: 10.1186/s13244-024-01612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is a relatively recent diagnostic technique increasingly being utilized in clinical practice. Until recently, there was a lack of standardized reporting for CEM findings. However, this has changed with the publication of a supplement in the Breast Imaging Reporting and Data System (BI-RADS). A comprehensive understanding of CEM is essential for further enhancing its role in both screening and managing patients with breast malignancies. CEM can also be beneficial for problem-solving, improving the management of uncertain breast findings. Practitioners in this field should become more cognizant of how and when to employ this technique and interpret the various CEM findings. This paper aims to outline the key findings in the updated version of the BI-RADS specifically dedicated to CEM. Additionally, it will present some clinical cases commonly encountered in clinical practice.Critical relevance statement Standardized reporting and a thorough understanding of CEM findings are pivotal for advancing the role of CEM in screening and managing breast cancer patients. This standardization contributes significantly to integrating CEM as an essential component of daily clinical practice.Key points • A complete knowledge and understanding of the findings outlined in the new BI-RADS CEM are necessary for accurate reporting.• BI-RADS CEM supplement is intuitive and practical to use.• Standardization of the CEM findings enables more accurate patient management.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100, Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100, Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Manuela Minenna
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Aurora Pesenti
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Diana Budascu
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Luciano Mariano
- Radiology Department, Università degli Studi di Torino, 10129, Turin, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
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Fontana F, Piacentino F, Gnesutta A, Macchi E, Coppola A, Saccomanno A, Gatta T, Recaldini C, Minenna M, Tamborini C, Dossi F, Ascenti V, Barbera S, Cicero G, Carcano G, Ascenti G, Castiglioni B, Venturini M. Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media. J Clin Med 2024; 13:524. [PMID: 38256659 PMCID: PMC10816911 DOI: 10.3390/jcm13020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Aroa Gnesutta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Angiola Saccomanno
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Tonia Gatta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Manuela Minenna
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Claudio Tamborini
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Filippo Dossi
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, Italy;
| | - Simone Barbera
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giuseppe Cicero
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Battistina Castiglioni
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
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Amati L, Caradonna L, Leandro G, Magrone T, Minenna M, Faleo G, Pellegrino NM, Jirillo E, Caccavo D. Immune abnormalities and endotoxemia in patients with ulcerative colitis and in their first degree relatives: attempts at neutralizing endotoxin-mediated effects. Curr Pharm Des 2003; 9:1937-45. [PMID: 12871178 DOI: 10.2174/1381612033454324] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Proinflammatory cytokines released from monocytes/macrophages, in particular tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, and IL-8 seem to play an important role in Inflammatory Bowel Disease (ulcerative colitis and Crohn's disease). Endotoxins or lipopolysaccharides, derived from the outer membrane of Gram-negative bacteria interact with CD14 on surface membrane of macrophages, thus triggering a signal cascade, which leads to the production and release of proinflammatory cytokines, particularly TNF-alpha. Therefore, in IBD, lipopolysaccharides could play a pathogenic role. In this respect, plasma endotoxins have been demonstrated in a not negligible percentage of patients with ulcerative colitis and in their unaffected relatives. The presence of circulating endotoxins could be due, at least in part, to the impaired natural immunity in either patients with ulcerative colitis or in their first degree unaffected relatives. Lactoferrin is an iron-binding glycoprotein, which binds to the lipid A region of lipopolysaccharide with a high affinity and this interaction prevents the binding of lipopolysaccharide to CD14, thus inhibiting the release of proinflammatory cytokines. Therefore, based on the possible pathogenic role exerted by endotoxins in ulcerative colitis, lactoferrin may deserve attention as a possible therapeutical agent in experimental models of Inflammatory Bowel Disease.
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Affiliation(s)
- L Amati
- IRCCS for Gastroenterological Diseases, Castellana Grotte, Bari, Italy
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