Deformable registration with intensity correction for CESM monitoring response to Neoadjuvant Chemotherapy

This paper proposes a robust longitudinal registration method for Contrast Enhanced Spectral Mammography in monitoring neoadjuvant chemotherapy. Because breast texture intensity changes with the treatment, a non-rigid registration procedure with local intensity compensations is developed. The approach allows registering the low energy images of the exams acquired before and after the chemotherapy. The measured motion is then applied to the corresponding recombined images. The difference of registered images, called residual, makes vanishing the breast texture that did not changed between the two exams. Consequently, this registered residual allows identifying local density and iodine changes, especially in the lesion area. The method is validated with a synthetic NAC case where ground truths are available. Then the procedure is applied to 51 patients with 208 CESM image pairs acquired before and after the chemotherapy treatment. The proposed registration converged in all 208 cases. The intensity-compensated registration approach is evaluated with different mathematical metrics and through the repositioning of clinical landmarks (RMSE: 5.9 mm) and outperforms state-of-the-art registration techniques.

The diagnostic accuracy of diffusion-weighted magnetic resonance imaging and shear wave elastography in comparison to dynamic contrast-enhanced MRI for diagnosing BIRADS 3 and 4 lesions

Background

Breast cancer is one of the leading causes of female morbidity and mortality. Management options vary between lesions of BIRADS categories 3 and 4. Therefore, reliable differentiation would improve outcome. Although sonomammography and contrast-enhanced breast magnetic resonance imaging (CE-MRI) remain the cornerstone for assessment of breast disease, additional, non-invasive techniques can be used to increase the efficiency of evaluation such as shear wave elastography (SWE) and diffusion-weighted magnetic resonance imaging (DW-MRI). This prospective study included 66 breast lesions that were categorized as BIRADS 3 or 4 by ultrasound ± mammography. All lesions were evaluated by SWE, CE-MRI and DW-MRI. For SWE, lesions were evaluated by both qualitative and quantitative methods. For CE-MRI, both morphological and kinematic evaluations were done and for DW-MRI, both qualitative and quantitative assessments were studied. Results of all imaging modalities were correlated to histopathology.

Results

Thirty-seven out of the examined 66 lesions (56.06%) were categorised as BIRADS 3, out of which 1 (2.7%) turned out to be malignant on histopathology and 36 (97.29%) were proved benign. Twenty-nine (43.93%) were categorized as BIRADS 4, out of which 2 (6.89%) turned out to be benign on pathology and 27 (93.1%) were proved malignant. Morphological and kinematic evaluations of CE-MRI showed 92.59% and 92.86%sensitivity, 94.74% and 84.21% specificity, 92.59 and 81.25%PPV, 94.74 and 94.12% NPV, and 93.85% and 87.88% accuracy respectively. Color-coded scoring of SWE showed indices of 89.29%, 68.42%, 67.57%, 89.66%, and 77.27% respectively. The calculated cut-off value for Emax differentiating benign from malignant was 65.15 kpa, resulting in indices of 96.43%, 57.89%, 95.65%, 62.79%, and 74.24% respectively. For Eratio, the calculated cut-off value was 4.55, resulting in indices of 71.43%, 68.42%, 76.47%, 62.50% and 69.70% respectively. For qualitative evaluation of DW-MRI, indices were 78.57%, 65.79%, 62.86%, 80.65%, and 71.21% respectively. For ADC, the calculated cut-off value was 1.25 × 103 mm2/s, which resulted in indices of 75.00%, 84.21%, 82.05%, 77.78%, and 80.30% respectively.

Conclusion

CE-MRI showed the best diagnostic performance indices. While, SWE and DW-MRI present variable diagnostic performance, both techniques can be used as an adjunct to other imaging modalities to aid the clinical decision and increase its diagnostic confidence.

Quantitative mathematical objective evaluation of contrast-enhanced spectral mammogram in the assessment of response to neoadjuvant chemotherapy and prediction of residual disease in breast cancer

Background

The aim of the study is to initiate a new quantitative mathematical objective tool for evaluation of response to neoadjuvant chemotherapy (NAC) and prediction of residual disease in breast cancer using contrast-enhanced spectral mammography (CESM). Forty-two breast cancer patients scheduled for receiving NAC were included. All patients underwent two CESM examinations: pre and post NAC. To assess the response to neoadjuvant chemotherapy, we used a mathematical image analysis software that can calculate the difference in the intensity of enhancement between the pre and post neoadjuvant contrast images (MATLAB and Simulink) (Release 2013b). The proposed technique used the pre and post neoadjuvant contrast images as inputs. The technique consists of three main steps: (1) preprocessing, (2) extracting the region of interest (ROI), and (3) assessment of the response to chemotherapy by measuring the percentage of change in the intensity of enhancement of malignant lesions in the pre and post neoadjuvant CESM studies using a quantitative mathematical technique. This technique depends on the analysis of number of pixels included within the ROI. We compared this technique with the currently used method of evaluation: RECIST 1.1 (response evaluation criteria in solid tumors 1.1) and using another combined response evaluation approach using both RECIST 1.1 in addition to a subjective visual evaluation. Results were then correlated with the postoperative pathology evaluation using Miller–Payne grades. For statistical evaluation, patients were classified into responders and non-responders in all evaluation methods.

Results

According to the Miller–Payne criteria, 39/42 (92.9%) of the participants were responders (Miller–Payne grades III, IV, and IV) and 3/42 (7.1%) were non-responders (Miller–Payne grades I and II). Using the proposed technique, 39/39 (100%) were responders in comparison to 38/39 patients (97.4%) using the combined criteria and 34/39 (87.2%) using the RECIST 1.1 evaluation. The calculated correlation coefficient of the proposed quantitative objective mathematical technique, RECIST 1.1 criteria, and the combined method was 0.89, 0.59, and 0.69 respectively. With classification of patients into responder and non-responders, the objective mathematical evaluation showed higher sensitivity, positive and negative predictive values, and overall accuracy (100%, 97.5%, 100%, and 85.7% respectively) compared to RECIST 1.1 evaluation (87.2%, 97.1%, 28.6%, and 54.8% respectively) and the combined response method (97.4%, 97.4%, 66.7%, and 85.7% respectively).

Conclusion

Quantitative mathematical objective evaluation using CESM images allows objective quantitative and accurate evaluation of the response of breast cancer to chemotherapy and is recommended as an alternative to the subjective techniques as a part of the pre-operative workup.

Oxidative Stress -a Phenotypic Hallmark of Fanconi Anemia and Down Syndrome: The Effect of Antioxidants

Background:

Oxidative stress plays a major role in the pathogenesis of leukemia-prone diseases such as Fanconi anemia (FA) and Down syndrome (DS)

Aim:

To explore the oxidative stress state in children with DS and FA by estimating the levels of antioxidants (e.g., malondialdehyde [MDA], total antioxidant capacity, and superoxide dismutase [SOD] activity) and DNA damage, and to evaluate of the effect of antioxidant treatment on these patients.

Subjects and methods

The study included 32 children clinically diagnosed with (15 patients) and FA (17 patients) in addition to 17 controls matched for age and sex. MDA, total antioxidant capacity, SOD activity, and DNA damage were measured. Antioxidants including Vitamin A, E, and C were given to the patients according to the recommended daily allowance for 6 months. Clinical follow-up and re-evaluation were conducted for all patients. Laboratory tests including complete blood count, karyotyping, DNA damage, and oxidative stress were re-evaluated. Statistical analysis was performed using statistical computer program Statistical Package for the Social Sciences version 14.0.

Results:

Children with FA and DS had elevated levels of oxidative stress and more DNA damage than controls. Oxidative stress parameters and DNA damage improved in FA and DS patients after antioxidant administration.

Conclusion:

Early administration of antioxidants to FA and DS patients is recommended for slowing of the disease course with symptoms amelioration and improvement of general health.

The most encountered groups of genetic disorders in Giza Governorate, Egypt

This study presents the prevalence, relative frequency, and analysis of genetic diseases/malformations in 73260 individuals. Cases included were ascertained from: Pediatric outpatient clinics of two governmental hospitals and two primary health care centers (PHCCs) in Giza Governorate; Neonatal intensive care unit (NICU) in the selected hospitals and Outpatients Human Genetics Clinics (NRC). 62819 persons visited the outpatients clinics of selected hospitals and PHCCs in Giza governorate. Out of these persons 731 cases (1.16%) proved to have known genetic disorders or malformations. 7755 neonates were delivered in the selected hospitals. Out of these neonates 666 newborns entered NICU and 3% (20 neonates) of them had genetic or congenital disorders. Also, 2686 patients were ascertained from the Human Genetics Clinics, NRC. The overall parental consanguinity rate among the 3417 diagnosed cases was 55%, ranging from 29.5-75%. The study showed a high prevalence of genetic/malformation disorders among Egyptians, with frequencies comparable to other Arab populations (Tab. 4, Ref. 25). Full Text (Free, PDF) www.bmj.sk.