ECR 2014, Part D
Insights into Imaging
Beyond imaging in breast MR: innovation and workflow optimisation in clinical practice Moderator L. Moy; New York, NY/US MR vacuum assisted biopsies and contrast injection optimisation F. Stöblen; Essen/DE Purpose: Visualisation of suspicious lesions in breast MRT for the MR-steered biopsy utilising an optimised contrasting protocol. Typically, the contrastenhanced MR visualisation of breast lesions with a single contrast agent administration is marred by a swift enhancement and an equally
... washout, resulting in an unfavourably short period of reliable focus delineation. Consequently, the biopsy based on such findings will be error prone, since the region of interest may have shifted after imaging or been erroneously identified in the first place. Since the reliable identification of relatively small foci is the main objective of contrast-enhanced breast MRT, these shortcomings seriously impair the method's explanatory power with respect to the important discrimination between benign and malignant lesions. The present study seeks to establish a protocol that provides the best possible diagnostic value in interventional contrast MRT-based breast lesion biopsy evaluation. Methods and Materials: MRT methods employed included 'reference' (single administration of 0.1 mMol/kg body weight, n = 11), 'single maximum dosage' (n = 11), 'continuously low' (n = 10), 'continuously high' (n = 13), and 'intermittent' (n = 9). MRT findings of 54 breast cancers by two different experienced examiners were evaluated. Both examiners rated the items 'image quality' (verbal rating scale [VRS] good -1, average -2, poor -3), 'visualisation' (excellent -1, good -2, moderate -3, poor -4, no -5), and 'confidence of diagnosis' (very confident -1, confident -2, not confident -3, not confident at all -4). Ratings of both examiners were assessed in terms of interand intra-rater reliability. Results: As compared to the reference (qualitycontrolled pathology), continuously low dosage yielded the best results (i. e. highest agreement between both examiners and the reference standard) across experimental conditions. Conclusion: Continuously low dosage might be the most explanatory examination modality for the MRT-guided interventional examination of breast lesions employing contrast-enhanced MRT. Economic aspects and the future of breast MR C.G.N. Kaiser; Mannheim/DE Purpose: The purpose of this study is to evaluate the economic aspects (cost vs. savings) of the use of MR with dense breasts as additional indication. Methods and Materials: The study included 1488 patients after dropout between 04/2006 and 12/2011. As result we found 76 true-positive cases (invasive cancers and/or DCIS), 48 false-positive cases, 971 true-negative cases and 0 false-negative cases. The true-negative findings were either confirmed by histology upon recommendation of an external institution (18 patients) or follow-up by MRM or patient questionnaires over the next 5 years by mail (1737 cases). 393 patients were lost to follow-up. Results: The overall costs for patients (MRM examinations, biopsies and costs of limited surgeries) included in this study resulted in expenses to the amount of € 1.53 Mio. (€ 1.187 Mio. MRM cost + € 304.000 for further treatment of true-positive findings + € 48.000 for the biopsy of 48 false-positive findings). On the contrary, the estimate amount of savings (prevented biopsies, reduced surgeries) ranged from € 2.65 Mio to € 4.15 Mio (€ 2.15 Mio in prevented biopsies and treatment + 76 true-positive findings, resulting in a total of € 0,5 -2 Mio. in less extensive treatment). This results in savings for the insurance company of € 1.1 Mio. -€ 2.6 Mio., i.e. a cost reduction of at least 50% could be achieved, in case MRM was performed under high-quality conditions (i.e. high specificity through reader experience) in dense breasts. Learning Objectives: 1. To learn appreciate the economic value and monetary benefits of MRM, analysing the cost reduction through the alteration of diagnostics and treatment. 2. To understand that optimal technical standards and reader experience seem inevitable prerequisites for the future adaption of MR indications. 3. To learn about MR-Mammography, though feasible, is probably not ready for "screening" today. Simultaneous acquisition of breast imaging with PET/MRI a powerful tool to better classify lesions L. Moy; New York, NY/US S372 The Ultrafast ultrasound revolution: current and future applications M. Tanter; Paris/FR ShearWave™ elastography of solid breast lesions: benign versus malignant differentiation and prediction of disease behavior A. Evans; Dundee/UK The advances of liver ultrasound imaging and innovative ShearWave™ elastography C.F. Dietrich; Bad Mergentheim/DE The advantages and clinical Impacts of ShearWave™ elastography in prostate imaging J. Walz; Marseille/FR 12:30 -13:30 Room N/O organised by Bayer Healthcare SY 4 Optimising contrast: thank you for your attenuation! Moderator J.E. Wildberger; Maastricht/NL Prelude. The recipe. J.E. Wildberger; Maastricht/NL Enhance! The clinics. M. Forsting; Essen/DE Encore. The outlook. U.J. Schoepf; Charleston, SC/US S373 12:30 -13:30 Room F2 organised by GE Healthcare SY 17 Developing innovative breast care solutions to improve clinical confidence Moderator D.B. Kopans; Boston, MA/US Breast tomosynthesis in diagnostic work-up A. Stork; Düsseldorf/DE EASY study: integration of automated 3D breast ultrasound (ABUS) into the routine workflow of a high-volume hospital-based breast cancer screening program in Stockholm, Sweden B. Wilczek; Stockholm/SE Role of MRI in the breast cancer pathway in challenging situations C.S. Balleyguier; Villejuif/FR 12:30 -13:30 Room G/H organised by Bracco SY 18 Personalising an integrated approach to CT imaging Moderator C.J. Herold; Vienna/AT Personalised CT imaging: are we there yet? M. Francone; Rome/IT Low Kvp protocols: what you should know T.