Browsing by Author "Nadrljanski, Mirjan (24280702200)"

Objectives The aim of this study was to contribute to the standardization of the numeric positive enhancement integral (PEI) values in breast parenchyma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) and to evaluate the significance of the difference in PEI values between IDC and parenchyma, DCIS and parenchyma and IDC and DCIS. Materials and Methods In the prospective trial, we analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of 60 consecutive patients with histologically confirmed unilateral DCIS (n = 30) and IDC (n = 30) and defined the PEI values (range; mean ± SD) for the lesions and the breast parenchyma. Tumor-to-non-tumor (T/NT) ratios were calculated for DCIS and IDC and compared. PEI color maps (PEICM) were created. The differences in PEI values between IDC and parenchyma and between DCIS and parenchyma were tested according to t-test. Analysis of variance (ANOVA) was used to test the differences between the mean PEI values of parenchyma, DCIS and IDC. Results IDC showed highly statistically different PEI numeric values compared to breast parenchyma (748.7 ± 32.2 vs. 74.6 ± 17.0; p < 0.0001). The same applied to the differences in the group of patients with DCIS (428.0 ± 25.0 vs. 66.0 ± 10.6; p < 0.0001). The difference between IDC, DCIS and parenchyma were also considered highly statistically significant (p < 0.0001) and so were the T/NT ratios for IDC and DCIS (10.1 ± 2.4 vs. 6.6 ± 1.4; p < 0.0001). Conclusions PEI numeric values may contribute to differentiation between invasive and in situ breast carcinoma. © 2014 Elsevier Ireland Ltd.

Ductal carcinoma in situ (DCIS), the noninvasive breast malignant tumor originates from the terminal ductal-lobular units (TDLU). The typical feature of DCSI is the formation of calcifications. Up to 90% of DCIS are diagnosed on mammographic examinations, as clinically asymptomatic. Between 10% and 20% of DCIS remain mammographically occult due to the lack of calcifications and/ or small tumor dimensions. Contrast-enhanced breast magnetic resonance imaging (MRI) detects mammographically occult breast lesions, thus defining morphologic features of the lesion and the dynamics of signal intensity changes due to contrast enhancement. Distribution of contrast enhancement - signal intensity increase in DCIS most frequently includes segmental, ductal and linear patterns, followed by regional enhancement pattern, while the intralesional contrast uptake most frequently includes the nodular pattern with the areas of confluence. Postcontrast signal intensity increase in DCIS is most frequently fast in the initial phase (wash-in), while the whole dynamic of contrastenhancement includes either of the three possible time-intensity curve (TIC) types (persistent, plateau or washout), although the plateau TIC is considered to be more frequent. Breast MRI has high sensitivity in the diagnosis of invasive breast cancer, varying from 90% to 100%; the sensitivity in the diagnosis of DCIS is lower (77-96%). For the time being, the primary role of MRI in DCIS is planning of breast-conserving surgery (BCS) for the evaluation of lesion extension. Further development of MRI in the diagnosis of DCIS includes the implementation of the principles of functional and molecular imaging.

Purpose: To investigate the influence of the vaginal packing volume on the registered dose parameters evaluated by radiography (2D) and computed tomography (CT) (3D) based brachytherapy planning in cervical cancer patients treated with postoperative radiotherapy. Methods: The postoperative radiotherapy was performed in 40 cervical cancer patients with increased risk for disease relapse. Both, radiography and CT based brachytherapy planning were done in all patients. Vaginal packing volume was evaluated by clinical target volume (CTV) uk , assessed on CT scans and analyzed according to the registered dose parameters: doses delivered to the organs at risk (OAR) and the defined CTV, using both planning methods. Results: CTV uk volume had statistically significant influence on CTV coverage with the prescribed brachytherapy doses D 90 (p<0.01) and D 100 (p<0.01), revealing a CTV uk cut-off value of 25.6 cm 3 . Dividing the patients into two groups according to the cutoff value, we found a statistical significance in the registered doses to the rectal wall and no significance in the bladder wall doses between the groups. Also, a statistically significant, negative correlation was found between CTV uk and following doses: R max (rho= -0.34, p<0.05), D 0.1cc (rho= -0.76, p<0.01), D 1cc (rho= -0.74, p<0.01) and D 2cc (rho= -0.72, p<0.01), D 90 (rho= -0.80, p<0.01), D 100 (rho= -0.7, p<0.01). Conclusion: If the brachytherapy vaginal packing is of a large volume (more than 25.6 cm 3 ), an asymmetric deformation of the proximal part of the vaginal cavity might appear, leading to inappropriate dose coverage of the CTV part of the vaginal mucosa. Also, making a vaginal packing volume larger than 25.6 cm 3 made no further reduction in the bladder dose, but it made a statistically significant further reduction in the rectal doses. © 2017 Zerbinis Publications. All rights reserved.

Purpose: To investigate the influence of the vaginal packing volume on the registered dose parameters evaluated by radiography (2D) and computed tomography (CT) (3D) based brachytherapy planning in cervical cancer patients treated with postoperative radiotherapy. Methods: The postoperative radiotherapy was performed in 40 cervical cancer patients with increased risk for disease relapse. Both, radiography and CT based brachytherapy planning were done in all patients. Vaginal packing volume was evaluated by clinical target volume (CTV) uk , assessed on CT scans and analyzed according to the registered dose parameters: doses delivered to the organs at risk (OAR) and the defined CTV, using both planning methods. Results: CTV uk volume had statistically significant influence on CTV coverage with the prescribed brachytherapy doses D 90 (p<0.01) and D 100 (p<0.01), revealing a CTV uk cut-off value of 25.6 cm 3 . Dividing the patients into two groups according to the cutoff value, we found a statistical significance in the registered doses to the rectal wall and no significance in the bladder wall doses between the groups. Also, a statistically significant, negative correlation was found between CTV uk and following doses: R max (rho= -0.34, p<0.05), D 0.1cc (rho= -0.76, p<0.01), D 1cc (rho= -0.74, p<0.01) and D 2cc (rho= -0.72, p<0.01), D 90 (rho= -0.80, p<0.01), D 100 (rho= -0.7, p<0.01). Conclusion: If the brachytherapy vaginal packing is of a large volume (more than 25.6 cm 3 ), an asymmetric deformation of the proximal part of the vaginal cavity might appear, leading to inappropriate dose coverage of the CTV part of the vaginal mucosa. Also, making a vaginal packing volume larger than 25.6 cm 3 made no further reduction in the bladder dose, but it made a statistically significant further reduction in the rectal doses. © 2017 Zerbinis Publications. All rights reserved.