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EH 1_2015

EUROPEAN HOSPITAL  Vol 24 Issue 1/15 16 EH @ ECR mMRI with DCE-MRI, DWI and Sodium Imaging: Female patient with low- grade, invasive ductal carcinoma in the central left breast area: (A-D). The DCE-MRI shows that the irregularly configured lesion has an increased tumour tissue permeability. (E) The lesion has limited movement of the hydrogen molecules with clearly lowered ADC levels (0.9 x 10-3 mm2/ sec). (F) Sodium imaging confirms an increased concentration of sodium. mMRI shows that the lesion is without doubt a malignant one (BI-RADS 5). Fast, uncomplicated and low in radiation Osteoporosis risk assessments witWomen over the age of 50 are not only at higher risk of developing breast cancer but also osteoporosis. Would it not be practical to use the same method to detect both dis- eases early on? Definitely, decided Sectra, the Swedish company spe- cialising in PACS and mammogra- phy systems. Based on interna- tional scientific studies and data, the company developed an algorithm that determines the risk of develop- ing osteoporosis based on digital radiology images of the hand. The equipment used for image acquisition utilises the low-dose mammography modality. First the breast and then why not the hand? For women who would like to have their bone density assessed, the Schwabing Radiology practice, in Munich, has been offering the spe- cial OneSceen solution by Sectra for several years, under the direction of Dr Michael Risch. Following a mammogram, the same digital radiology equipment is used to take an additional X-ray of the hand. This is sent to a trained expert at Sectra in Sweden where it enters the PACS along with the mammography image. The expert checks whether all parameters important to the evaluation of the examination have been met – the metacarpal bones of the index fin- ger, middle finger and ring finger being the important ones – and puts the images through a specially developed programme. ‘In our prac- tice we offer three procedures to measure bone density: Quantitative Computed Tomography (QCT), Dual-energy X-ray Absorptiometry (DXA) and digital radiology exami- nations with low-dose mammog- raphy. The latter are particularly suitable for early screening where there is no evidence of suspected disease as the procedure is carried out with only a very small radiation dose of just a few microsieverts,’ explains Dr Michael Risch, who has gained very good experience with the procedure with the initial selec- tion of patients. Apart from low radiation dose, the ease and speed of the examina- tion particularly make the proce- dure highly attractive for routine medical practice. ‘Acquiring images is a matter of seconds and the evaluation is fully automated. This is extremely convenient and allows us to offer this service, which is not covered by the statutory medical insurers o patients at a reasonable price – quite a bit less than one hun- dred euros,’ he points out. ‘If, based on the Sectra evaluation, osteope- nia, i.e. early stage osteoporosis, is diagnosed, further examinations are carried out for quantification and then treatment is recommended. Global data comparison Sectra OneScreen already allows significant conclusions about bone density, according to Maria Bolin, General Manager and head of Sectra’s Osteoporosis Division: ‘Our system measures more than 1,000 points on the metacarpal bones of the three middle fingers. The sys- tem evaluates the volume as well as the curvature of the bones and the data is then used to determine the Michael Risch has used OneScreen for years in Munich Breast cance Can, should and must MRI replace mammography?In breast cancer care each patient receives personalised, highly effec- tive diagnosis and treatment pro- cedures. In breast diagnostics this mainly revolves around new MRI scanning procedures that allow the quantification of biological and physiological processes on a cel- lular and molecular level. ‘The talk here is of molecular MRI (mMRI), which even today makes it possible to differentiate between benign and malignant breast cancers without needing biopsies, with an impact on treatment procedures – such as minimising over-diagnosis – and of the early prediction of the therapy response of individual cancers,’ says Professor Thomas H Helbich, Vice Chairman of the University Department of Radiology and Nuclear Medicine at Vienna’s Medical University. During this year’s MR symposium in Garmisch, his lecture centred on mMRI. Various processes, such as tumour angiogenesis, cell prolif- eration, molecular movement and numerous metabolic changes, play a key role in the development of breast cancer. mMRI facilitates the quanti- fication of these key processes on a cellular and subcellular level. ‘The combined use of different MRI pro- cedures, such as contrast enhanced MRI, diffusion weighted imaging (DWI) and MR-Spectroscopy (MRS) provides first insights into the world of mMRI. This method allows us to measure multiple imaging biomark- ers simultaneously and non-inva- sively,’ Prof. Helbich explained. It has been shown that the acquisition of these parameters enhances speci- ficity considerably without over- looking breast cancer. Therefore he advocates increased use of mMRI in routine breast diagnostics. MRI also plays a vital role in mon- itoring cancer therapy. Depending on the chosen procedure it enables doctors to differentiate between cancers that do or do not respond to treatment shortly after it begins. This means, the professor explains, that MRI meets all the requirements for implementation in personalised medicine: Treatments that do not have the right effect can be replaced by more efficient procedures.

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