Contrast-Enhanced MR Angiography of The Breast

This is an abstract copied from PubMed. Am I the only one that wonders how vessel density on MR and not the vessel density on a therm is accurate? True: thermography measures skin blood flow by temp - but more vascularity usually means more blood flow -- ????? Am I missing something?

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions Sibel Kul1 Aysegül Cansu1 Etem Alhan2 Hasan Dinc1 Abdulkadir Reis3 Gamze Çan4 Kul S, Cansu A, Alhan E, Dinc H, Reis A, Çan G 1Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. Address correspondence to S. Kul (sibel_ozy@yahoo.com). 2Department of General Surgery. Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 3 Department of Pathology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 4 Department of Public Health, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 􀀷􀁏􀁍􀁅 􀁎 􀀇􀁓 􀀀 􀀩􀁍􀁁 􀁇 􀁉 􀁎 􀁇 􀀀 􀁳 􀀀􀀯 􀁒 􀁉 􀁇 􀁉 􀁎 􀁁 􀁌 􀀀 􀀲 􀁅 􀁓 􀁅 􀁁 􀁒 􀁃 􀁈

AJR 2010; 195:1250–1254 0361–803X/10/1955–1250 © American Roentgen Ray Society

MRI is the most accurate method of detection of invasive breast cancer, having nearly 100% sensitivity. The specificity, however, is only moderate (72% overall specificity in 44 studies) and varies widely across studies of the diagnostic performance of breast MRI related to cancer prevalence and the criteria used to differentiate malignant and benign lesions [1]. Developments in MRI systems, image acquisition protocols, and image interpretation methods are continuing to improve specificity. The results of previous studies have shown an association between breast cancer and ipsilateral increased blood flow at laser Doppler imaging [2] and PET [3]. It is possible to obtain MR angiograms of the breast with postprocessing of 3D dynamic contrast-enhanced MR images. Maximum-intensity-projection (MIP) reconstruction of subtracted dynamic MR images shows enhancing lesions and the breast vasculature at the same time. Increased vascularity adjacent to breast cancer lesions and in the ipsilateral breast as a whole has been found Keywords: breast, contrast-enhanced MRI, MR angiography, MRI, vascularity DOI:10.2214/AJR.10.4368

Received January 28, 2010; accepted after revision March 25, 2010. W O M E N ’ S I M A G I N G

􀀯􀀢􀀪􀀥􀀣􀀴􀀩􀀶􀀥􀀎 The purpose of this study was to investigate the role of evaluation of breast vascularity with contrast-enhanced MR angiography in the differentiation of malignant from benign lesions. 􀀭􀀡􀀴􀀥􀀲􀀩􀀡􀀬􀀳􀀀􀀡􀀮􀀤􀀀􀀭􀀥􀀴􀀨􀀯􀀤􀀳􀀎

Contrast-enhanced 3D MR angiograms of the breasts of 102 patients with unilateral and histopathologically confirmed breast lesions were evaluated retrospectively. All images were evaluated for both ipsilateral increased vascularity and adjacent vessel sign, and the values of these signs in the diagnosis of malignancy were assessed. 􀀲􀀥􀀳􀀵􀀬􀀴􀀳􀀎

Histopathologic analysis of 102 patients revealed 50 malignant and 52 benign results. In 31 of the 50 patients with breast cancer and in 11 of the 52 patients with benign lesions, ipsilateral breast vascularity was increased. The resulting sensitivity and specificity of ipsilateral increased vascularity were 62% and 79%. The adjacent vessel sign was present in 37 of the 50 patients with breast cancer and six of the 50 patients with benign lesions. The resulting sensitivity and specificity of the adjacent vessel sign were 74% and 89%. The overall accuracies of ipsilateral increased vascularity and the adjacent vessel sign were 71% and 81%. 􀀣􀀯􀀮􀀣􀀬􀀵􀀳􀀩􀀯􀀮􀀎

Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043).

ARE YOU LIVING IN FEAR OF BREAST OR OTHER CANCER?

Fear is beneficial (as far as I'm concerned) in acute life-threatening situations; tigers (outside the bars), mad dogs, men with weapons etc. Fear of the unknown or fear of possibility is the worst -- as it is the ongoing stress hormones that are secreted by this type of fear that can cause or accelerate disease.

I personally believe that we create our problems and diseases with our thoughts. Unfortunately those thoughts (negative) create the very thing we fear or do not want. We become what we focus on --- if you focus on illness then wellness isn’t the outcome.

The body is an incredible work of art. It is SO complex. But everything in the body begins with chemistry. You don’t lift a finger or a foot to run unless the chemistry directs the action. Very complicated and immediate discharges of cellular transmitters start all activities (that’s where the hormones of fear come into play ....) If you truly have a fear of cancer – then the chemistry is probably in action. Getting structural tests such as mammography show the changes long after the chemistry has been in play. I encourage you to save your pennies and get a Cancer Profile study from American Metabolic Laboratory. Specifically request or include the addition of thymidine kinase levels in the test.

This is taken from Wiki’s information on TK1 Clinical chemistry[edit]Thymidine kinase is a salvage enzyme that is only present in anticipation of cell division. The enzyme is not set free from cells undergoing normal division where the cells have a special mechanism to degrade the proteins no longer needed after the cell division.[10] In normal subjects, the amount of thymidine kinase in serum or plasma is therefore very low. Tumour cells release enzyme to the circulation, probably in connection with the disruption of dead or dying tumour cells. The thymidine kinase level in serum therefore serves as a measure of malignant proliferation, indirectly as a measure of the aggressivity of the tumour.

If the fear of cancer drives you --- then this is the way to go. Your practitioner probably doesn’t know about this test – and won’t recommend anything that isn’t in the “Betty Crocker recipe book for finding and treating cancer”. They only follow algorithms. If A then B – If B then........ . They can’t practice any other way – or they get some type of oversight...

This is what I suggest – but if you’re of the mind to wait and see.............

Caveat emptor - Radiology is NOT Thermography and Thermography is NOT Structural

What Do Thermal Indicators Mean?

Infrared thermal imaging determines if abnormal or asymmetric thermal patterns, consistent with abnormal physiology, are detectable in the breast tissue. This procedure is used as an adjunctive diagnostic procedure in addition to structural tests, not in place of those tests. Thermal imaging is an ideal marker to indicate your level of RISK for breast cancer and also can assist as an indicator of “activity” if a cancer is present. The higher the tissue temperature -- the greater the cellular activity.

Not all ‘cancers’ emit a thermal signal. “DCIS, LCIS and Atypia” are considered cancerous or precancerous on mammography and MAY NOT demonstrate a thermal signal at this time. Additionally – thermal signals can be present within one or both breasts – but may not be located adjacent to a cancer; blood supply is called to a tumor and is not initiated at the tumor. Mammography may locate a cancer in the opposite breast. This is a physiological signal NOT a structural test. A normal TH factor does not rule out the possibility of cancer detectable by mammogram.

Thermal Indicator: TH-1 Symmetric Bilateral – Non-Vascular (normal) TH-2 Symmetric Bilateral – Vascular (normal) TH-3 Equivocal – One Thermal Factor Present (equivocal) TH-4 Abnormal – Two Factor Present (abnormal) TH-5 Suspicious - Three Factors Present (suspicious for malignancy) ,

Your recall period is based on your Thermal Risk indicators. Tumor doubling time averages 150 days. A 3-month recall will determine if your TH Factors are stable or require additional investigation by structural study. Follow-up studies of 6 – 12 months are considered Standard. Recall procedure is important to monitor breast health and to follow any demonstrated changes in either the Risk Index or Thermal Indicator Scale. Statistics have demonstrated that abnormal serial scans demonstrate a greater potential (higher RISK) for conversion than other RISK markers.