The potential role of dedicated 3D breast CT as a diagnostic tool: review and early clinical examples.
The potential role of dedicated 3D breast CT as a diagnostic tool: review and early clinical examples.
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DOI：
10.1111/tbj.12327
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发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Vedantham S
中科院分区：
文献类型：
--
作者：
O'Connell AM;Karellas A;Vedantham S
乳腺X线摄影是普通人群中检测乳腺癌的常规筛查的金标准。然而，灵敏度的限制，特别是在致密乳房中，已经促使替代成像技术的发展，例如数字乳房断层合成、全乳房超声、乳房特异性伽马成像，以及最近专用的乳房计算机断层扫描或“乳房CT”。几乎所有无症状的不可触及发现的诊断性检查都来自筛查性乳房X线摄影。在大多数情况下，诊断性乳房X光检查和超声足以进行诊断，磁共振成像（MRI）偶尔也发挥作用。数字乳腺断层合成摄影，一种有限角度的断层摄影技术，正越来越多地用于筛查。专用乳腺CT具有接近各向同性分辨率的全三维（3D）功能，这可能会提高诊断准确性。在当前专用的乳腺CT临床原型中，使用平板探测器在围绕乳腺的圆形轨迹中采集300-500个低剂量投影，随后进行图像重建以提供3D乳腺体积。乳腺CT对乳腺的平均腺体剂量范围可以从低至双视图筛查乳房X线摄影到大约诊断性乳房X线摄影检查。乳腺CT显示乳房内部结构的3D图像;因此，可以在单次扫描的多个解剖平面中对可疑特征（如微钙化、肿块和不对称）进行评估。通过临床实例，如成像软组织异常和微钙化，说明了乳腺CT在诊断成像中的潜在作用。潜在的乳腺CT作为一种成像工具的疾病程度的评估和监测新辅助化疗反应也说明。
Mammography is the gold standard in routine screening for the detection of breast cancer in the general population. However limitations in sensitivity, particularly in dense breasts, has motivated the development of alternative imaging techniques such as digital breast tomosynthesis, whole breast ultrasound, breast specific gamma imaging, and more recently dedicated breast computed tomography or “breast CT”. Virtually all diagnostic work-ups of asymptomatic nonpalpable findings arise from screening mammography. In most cases, diagnostic mammography and ultrasound are sufficient for diagnosis, with magnetic resonance imaging (MRI) playing an occasional role. Digital breast tomosynthesis, a limited-angle tomographic technique, is increasingly being used for screening. Dedicated breast CT has full three-dimensional (3D) capability with near-isotropic resolution, which could potentially improve diagnostic accuracy. In current dedicated breast CT clinical prototypes, 300-500 low-dose projections are acquired in a circular trajectory around the breast using a flat panel detector, followed by image reconstruction to provide the 3D breast volume. The average glandular dose to the breast from breast CT can range from as little as a two-view screening mammogram to approximately that of a diagnostic mammography examination. Breast CT displays 3D images of the internal structures of the breast; therefore, evaluation of suspicious features like microcalcifications, masses, and asymmetries can be made in multiple anatomical planes from a single scan. The potential role of breast CT for diagnostic imaging is illustrated here through clinical examples such as imaging soft tissue abnormalities and microcalcifications. The potential for breast CT to serve as an imaging tool for extent of disease evaluation and for monitoring neoadjuvant chemotherapy response is also illustrated.
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