KEYWORDS: Digital breast tomosynthesis, Breast, Autoregressive models, Imaging systems, Quantum reading, Diagnostics, Breast density, Quantum noise, Tissues, Cancer detection
Digital breast tomosynthesis (DBT) has been shown to improve both sensitivity and specificity for breast cancer detection compared to full-field digital mammography. However, its performance could be limited for patients with dense breasts. Clinical DBT systems vary in their system designs, one of which is the acquisition angular range (AR), which leads to varied performance for different imaging tasks. In this study, we aim to compare DBT systems with different AR. We used a previously validated cascaded linear system model to investigate the dependence of in-plane breast structural noise (BSN) and detectability of masses on AR. We conducted a pilot clinical study to compare the lesion conspicuity between clinical DBT systems with the narrowest and the widest AR. Patients called back for diagnostic imaging on suspicious findings were imaged with both narrow-angle (NA) and wide-angle (WA) DBT. We analyzed the BSN for clinical images using noise power spectrum (NPS) analysis. A 5-point Likert scale was used in the reader study to compare the lesion conspicuity. Our theoretical calculation results show that increasing AR leads to reduced BSN and improved mass detectability. The NPS analysis on clinical images shows the lowest BSN for WA DBT. The WA DBT provides better lesion conspicuity for masses and asymmetries and shows a greater advantage for non-microcalcification lesions in dense breasts. The NA DBT provides better characterizations for microcalcifications. The WA DBT can downgrade false-positive findings seen on NA DBT. In conclusion, WA DBT could improve the detection of masses and asymmetries for patients with dense breasts.
Contrast-Enhanced Digital Breast Tomosynthesis (CEDBT) provides quasi three-dimensional contrast enhancement of breast lesions and has been investigated for breast cancer detection and lesion assessment. The acquisition geometry of CEDBT may affect its ability to detect and assess contrast-enhanced lesions. In this study, we investigate the effects of angular range of CEDBT on lesion margin assessment. The CIRS BR3D phantom with iodine inserts was imaged for four angular ranges between 15 and 45 degrees with same total glandular dose using a prototype CEDBT system. The artifact spread functions of iodine objects with various sizes were measured. The detectability of iodine objects overlaid in the depth direction with different separation distances was evaluated using signal-difference-to-noise ratio. Clinical images of malignant lesions were acquired with 25 projections over approximately 50 degrees, and CEDBT for various angular ranges were generated using a subset or all of the projection images and were assessed for lesion margins. Our results show that increasing angular range of CEDBT improves the separation of overlapping iodine signals in phantom images, and the margins of malignant mass lesions are better identified. In conclusion, CEDBT with wide angular range may improve lesion characterizations, e.g. lesion size, morphology and location, and provide better performance than contrast enhanced digital mammography (CEDM) for applications such as guidance of biopsy and evaluation of treatment response.
Contrast-enhanced digital mammography (CEDM) reveals neovasculature of breast lesions in a two-dimensional contrast enhancement map. Contrast-enhanced digital breast tomosynthesis (CEDBT) provides contrast enhancement in three dimensions, which may improve lesion characterization and localization. We aim to compare CEDM and CEDBT for lesion assessment. Women with breast imaging-reporting and data system 4 or 5 suspicious breast lesion(s) were recruited in our study and were imaged with CEDM and CEDBT in succession under one breast compression. Two radiologists assessed CEDM and CEDBT with both images displayed side-by-side and compared (1) contrast enhancement of lesions and (2) lesion margin using a five-point scale ranging from −2 (CEDM much better) to +2 (CEDBT much better). Biopsy identified 19 malignant lesions with contrast enhancement. Our results show that CEDBT provides better lesion margins than CEDM with limited reduction in contrast enhancement. CEDBT delivers less radiation dose compared to CEDM + DBT. Synthetic CEDM can be generated from CEDBT data and provides lesion contrast enhancement comparable to CEDM. CEDBT has potential for clinical applications, such as treatment response monitoring and guidance for biopsy.
The detection of cancerous mass lesions using digital breast tomosynthesis (DBT) has been shown to be limited in patients with dense breasts. Detection may potentially be improved by increasing the DBT angular range (AR), which reduces breast structural noise and increases object contrast in the reconstructed slice. We investigate the impact of DBT AR on the detection of masses in a simulation study using a cascaded linear system model (CLSM) for DBT. We compare the mass conspicuity between wide- and narrow-AR DBT system in a clinical pilot study. The simulation results show reduced in-plane breast structural noise and increased in-plane detectability of masses with increasing AR. The clinical results show that masses are more conspicuous in wide-AR DBT than narrow-AR DBT. Our study indicates that the detection of mass lesions in dense breasts can be improved by increasing DBT AR.
Contrast-Enhanced Digital Breast Tomosynthesis (CEDBT) provides a three-dimensional (3D) contrast-enhancement map with co-registered anatomical information from low-energy DBT. It combines the benefits from Contrast-Enhanced Digital Mammography (CEDM) and Digital Breast Tomosynthesis (DBT), and may improve breast cancer detection and assessment of lesion morphology. We investigate the efficacy of CEDBT in the assessment of lesion contrast enhancement and margin identification, and evaluate the dose efficiency. We generate synthetic CEDM images from CEDBT data, similar to synthesis of 2D mammograms from DBT data, which may facilitate overall lesion assessment without additional radiation dose. Preliminary results from a patient study show that CEDBT depicts lesion margins better compared to CEDM, while the contrast-enhancement level for in-plane slice is not as high as in CEDM. CEDBT delivers less radiation dose compared to CEDM + DBT. Synthetic CEDM is able to provide lesion contrast-enhancement level comparable to CEDM.
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