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Computer Aided Detection Now Utilized With Breast MR Imaging
Computer aided detection (CAD) has been routinely used at Northwest Community since 2003 for mammographic interpretation. Recently, the CADstream™ computer aided detection system has been incorporated into our routine interpretation of breast MR imaging examinations. CADstream™ reduces artifact (eg, cardiac pulsation, other motion), subtracts precontrast from postcontrast images to aid in the visualization of enhancing lesions, performs multiplanar reformations, and creates three dimensional and volume measurement of lesions. Perhaps most importantly, CADstream™ generates angiogenesis maps and curves to assist in the differentiation of benign from malignant enhancement patterns.
CC view mammographic image of the right breast (rotated 90°) in a 64-year-old woman after percutaneous biopsy of small group of microcalcifications shown histologically to represent ductal carcinoma in situ. No residual calcifications or other suspicious findings are evident mammographically, with the tiny marking clip (red arrow) deployed during the diagnostic procedure present.
CADstream™ generated maximum intensity projection (MIP) image of the right breast in the axial plane (oriented identically to the CC view mammogram) obtained from a contrast-infused MR imaging examination subsequently performed for staging purposes. There is a large area of suspicious enhancement surrounding the biopsy site (red arrow) suggesting mammographically occult residual tumor, and a second smaller area of suspicious enhancement is present separately in the more posterior breast (yellow arrow).
CADstream™ created angiogenesis maps of the suspected residual tumor (left image) and the second smaller lesion (right image). The presence of red color within both lesion maps indicates the rapid washout pattern of enhancement strongly associated with malignancy. The CADstream™ software has also measured each lesion in three dimensions (the two transverse measurement shown). Invasive ductal carcinoma was found surgically at both locations and corresponded well in size to the CADstream™ calculated measurements.
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Carotid Artery Stenting As An Alternative to Endarterectomy
The interventional radiologists at Northwest Community are now offering carotid artery stenting (CAS) as an alternative to endarterectomy. CAS has recently been approved by the FDA and is reimbursed by Medicare/CMS for symptomatic high risk patients. Our interventional radiologists are the first physicians at the hospital to offer this service.
The angiographically performed procedure involves placing an embolic protection device beyond the stenosis prior to stent placement. This device is a basket that will collect any plaque that may break off during stent placement. Once the stent is deployed, the protection device is removed.
Potential candidates for CAS need to be symptomatic (eg, TIA, CVA, or amaurosis fugax) and also have at least one of the following: restenosis after endarterectomy, prior radiation treatment to the neck, prior radical neck surgery, surgically inaccessible lesions, tracheostomy placement, spinal immobility, contralateral laryngeal nerve palsy, or be at high risk for general anesthesia. To consult with an interventional radiologist about this procedure, please call (847) 618-5890.
77-year-old man with prior neck surgery and radiation for carcinoma who now presents with TIA symptoms. A carotid Doppler examination (not shown) revealed a critical left-sided stenosis. The angiogram above confirms a greater than 90% stenosis (red arrow) in the proximal left internal carotid artery.
Angiogram of the same patient after CAS. The patient tolerated the procedure well, and there is no residual stenosis.
Thanks to Dr. Evan Oblonsky for the information on carotid artery stenting.
For more information about Northwest Radiology Associates, the services we provide, and how to contact individual radiologists, please visit our web site: northwestradiologyassociates.com
If you are reading a printed version of this newsletter and would like to receive future editions electronically, please contact: ckalbhen@northwestradiologyassociates.com
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