Software Enhancement Of Breast MRI Scans Help Radiologists Reduce False Positives

Using commercially available software to enhance breast scans done by magnetic resonance imaging (MRI) reduces the number of false positive identifications of malignant tumors and the subsequent need for biopsies, according to a new study.

Teresa Williams, M.D., and colleagues at the Seattle Cancer Care Alliance and the University of Washington Medical Center did a retrospective examination of 154 breast lesions deemed suspicious by radiologists that were only visible on MRI and that had been biopsied under MRI guidance. They compared the findings and recommendations made by radiologists at the time to new findings using computer-aided enhancement (CAE) software to enhance and evaluate the visible response to contrast agents absorbed by breast tissue.

False positives were reduced by 23 percent when CAE was set to its highest enhancement level, according to the study, which is published in the July edition of the journal Radiology. Williams was a medical resident in radiology at the Seattle Cancer Care Alliance (SCCA) when the research was done. She is now a fellow in pediatric radiology at Children's Hospital and Regional Medical Center in Seattle.

"In summary, our findings suggest that CAE has the potential to improve the discrimination of benign and malignant breast MRI lesions," the authors wrote. "We believe that CAE is useful as a tool to supplement the radiologist's subjective interpretation, but should not be relied upon exclusively to guide management."
"There are challenges associated with breast MRI and one is the time it takes to process and evaluate the many images acquired," said Constance Lehman, M.D., corresponding author and director of radiology at the SCCA. "Computer software programs such as the one evaluated in our study can assist us in interpreting breast MRI scans more easily. Our study suggests that the information provided may improve our ability to distinguish between benign and malignant lesions. Currently, MRI scans are used in addition to mammography when radiologists need a better view of tissue they suspect may be malignant.

MRI as an adjunct to mammography also is standard practice at the SCCA for women who are at high risk for breast cancer and to examine the other, or contralateral, breast of women who are newly diagnosed.
One particular challenge in breast MRI is the interpretation of the morphology and kinetic features -- the amount of contrast agent absorbed by breast tissue over time -- on multiple imaging series. Typically, a woman will receive one scan without contrast agent and two more after contrast has been administered. One key analysis function performed by CAE is automatic kinetic assessment.
"The detailed CAE lesion kinetic information differs substantially from that obtained by conventional manual placement of a region of interest," the authors wrote. This is because CAE generates detailed data for the entire lesion versus only a portion of the lesion that is highlighted by region-of-placement.

The lesions in the study had been identified and biopsied during 2001-2004 and came from 125 women ages 27-86. They were processed using CADstream™ 3.0, a CAE system developed by Confirma, Inc. of Kirkland, Wash. The presence of CAE threshold enhancement was sensitive for malignancy in 38 of the 41 malignant lesions examined using the software, according to the study. However, the software did not perform perfectly; it failed to confirm the malignancy of the three lesions. "Given the presence of three false-negative lesions, a finding deemed suspicious by the radiologist should be further evaluated regardless of the enhancement features determined by CAE," according to the study.

Williams said she advocates the use of CAE software analysis of MRI scans as an aid to radiologists' interpretations. "The software is already commercially available and it has shown it is useful in reducing the false positive rate of breast MRI," she said.
Summary of how CAE software works
From the journal paper: The CAE software incorporates three MRI series into its calculations: one pre-contrast T1 weighted series, one immediate post-contrast T1 weighted series and one delayed post-contrast T1 weighted series. The program compares pixel signal intensity values on the pre-contrast and immediate post-contrast series. If a pixel value increases above a user specified minimum enhancement threshold such as a 50 percent or 100 percent increase in enhancement, the pixel is said to meet "threshold enhancement."

Once a pixel has been identified as enhancing above the established threshold, the program then compares pixel signal intensity values on the immediate and delayed post-contrast series. If a pixel value on the delayed series decreases by more than 10 percent compared to the immediate post- contrast series, it is color-coded red, indicating a washout pattern of enhancement. If a pixel value increases by more than 10 percent it is color-coded blue, indicating persistent enhancement.

If a pixel value does not change in either direction by more than 10 percent it is color-coded green, for plateau enhancement. One of three colors (blue, green, or red) is applied to that pixel based on the delayed enhancement pattern.
This results in a color overlay map that is displayed on each MRI image, indicating regions of threshold enhancement.

Areas of threshold enhancement determined by the CAE software algorithm to be "connected" are summed and constitute a lesion. A synopsis of the kinetic enhancement details of the total connected area or lesion is automatically generated.

So True....

In today's world, appearance matters. Considering how fast and hectic our day-to-day routine has become and how little free time, we have to rely more and more on snap judgments. This reality extends to how we look. Like it or not, much of our opinions on others and ourselves are based on physical appearance. Although style and body language are factors as well that can enhance or detract from our physical appearance, the fact of the matter is that appearance counts. Considering the incredibly large number of products and services available that are designed to enhance how we look, people are even less sympathetic than before about how others look.

Breast Enhancement Surgery

Breast enhancement is a rapidly growing area of cosmetic plastic surgery, and includes several breast surgery procedures. Cosmetic breast procedures include breast augmentation (breast enlargement), which is accomplished with breast implants. Breast lift is a procedure which is often performed simultaneously with an augmentation. In addition to these purely cosmetic procedures, breast reduction is an enhancement surgery that potentially offers both health and cosmetic benefits.

Breast Reduction

Women who have very large breasts may experience a number of medical problems that are caused by the excessive weight. This is why breast liposuction is useful - it reduces the size of the breasts and frees women from chronic back and neck pain and skin irritation as well skeletal deformities and breathing problems that are due to oversized breasts. Breast reduction liposuction is also useful for reducing the size of breasts that essentially cause bra straps indentations in shoulders and in younger women it frees them embarassment due to the extra attention.

Breast liposuction procedure is designed to remove fat from the breasts, making them smaller, lighter, and firmer. Occasionally, the breast reduciton liposuction can also reduce the size of the areola. The goal is to give the woman smaller, well-shaped breasts that are in proportion with the rest of the figure.

In plastic surgery, breast liposuction reduces the amount of fat in the breast region for both female and male patients. Breast liposuction is less painful than traditional breast reduction surgery and ususally it doesn't require general anesthetic. Also breast liposuction is virtually scarless, while traditional breast reduction surgery usually leaves large some scarring.

-www.mybodypart.com

The physical aspect

In every surgical procedure, there are inherent risks. Most people are intimidated by the thought of 'going under the knife', even when it's medically necessary.
Cosmetic surgery, however, is just that -- cosmetic. It's not necessary to sustain health or treat disease, and therefore, taking the leap is even harder to justify.

During breast augmentation, the patient is put to sleep using general anaesthesia. Measuring the proper dosage can be very difficult for anaesthesiologists, because each individual reacts differently to the sleep-inducing drugs used. About five anaesthetic treatments per 1,000,000 result in death, usually caused by organ failure and suffocation.
Aside from the risks of surgery itself, there are many complications linked to breast enhancement. Implants have been known to shift, swell and wrinkle. Common complications include infection, loss or change of nipple sensitivity, breast pain and interference with breast feeding.

Moreover, practically all women who opt for breast enhancement procedures require several operations in their lifetimes -- implants should ideally be replaced once every decade. In drastic cases, as many as seven or eight procedures are conducted on a single patient.

Common reasons for follow-up surgery include ruptured implants, the asymmetric or lop-sided appearance of one or both breasts, and pain -- in some instances, an individual's body rejects the implants, and is not able to establish compatibility with them.
Also, there is no way to avoid scarring under the breasts. Though some women heal quickly, for others it is a terrible problem. A survey conducted in the United States revealed that about 7 percent of patients were unhappy with their enhancement procedures because of scarring.
Finally, there is the issue of quality to consider.

In the United States and Europe, where cosmetic surgery has been popular for over 20 years, there are medical boards and committees that govern facilities and doctors undertaking to perform such procedures. In India, on the other hand, the lack of regulations allows any quack to try his hand at cosmetic surgery. Outside of Mumbai and Delhi, there are very few properly trained and licensed specialists in breast augmentation.

When Do Breasts Start Growing?

Breasts can start growing as early as age 8 or as late as 13. Some girls' breasts grow slowly and others grow quickly. Some girls may feel like their breasts will never start growing. But it's just that girls start developing at different ages and different rates. One girl might have more developed breasts at 12, whereas her friend could be still flat as a board.
Breast development happens in stages.

The first stage starts during the early part of puberty, when a girl's ovaries enlarge and estrogen, an important female hormone, begins to circulate in the body. Doctors often refer to the early stages of breast development as "breast budding." Get it? Budding — like a flower has buds.

A breast bud is like a small raised bump behind the nipple. After breast budding happens, the nipple and the circle of skin around the nipple (called the areola) get bigger and a little darker. Then the area around the nipple and areola starts to grow into a breast.

As breasts keep growing, they may be pointy for a while before becoming rounder and fuller. For some girls, one breast might be a little bigger than the other one. A girl's breasts may continue to grow during the teen years and even into her early twenties. Fully developed breasts come in all shapes and sizes.

Breast size gets a lot of attention and many girls may wonder how they can make their breasts grow faster or bigger. Despite what some magazine ads say, there isn't any magic cream or pill that can speed up the process or make a girl's breasts larger than they are. In fact, breast size is mostly determined by heredity and a girl's weight. So if a girl's mother has big breasts or small breasts, the girl can expect to have breasts of similar size. And a girl who has more body fat is more likely to have larger breasts.

When you are thinking about surgically increasing the size of your chest it is important that you know what to expect before and after breast enhancement.

The first step before breast enhancement is the consultation. The consultation involves meeting with the plastic surgeon that you have chosen to perform your procedure and discussing with them the result you are after. They will likely give you their opinion about the size of implant that will best suit your body and together you will decide on the type of result that will be most appropriate.During the consultation you will probably be required to undergo a physical examination and have blood tests done to ensure that you are a good candidate for surgical breast enhancement. If your surgeon determines that you are fit to undergo surgery you will probably be required to set up a pre-operative appointment.

Your pre-operative appointment will likely take place about two weeks before your surgery is scheduled. During this appointment make sure that all of your questions have been answered. Be sure that you know about the type of anesthetic that will be used, the types of incisions that will be made and how long you will need to be in the hospital for. After all of your questions have been answered you will feel much more comfortable going into surgery. During the pre-operative appointment you should expect to sign consent forms. Your surgeon will also likely take pictures of your breasts at this time to consult during and after surgery.

It is a good idea to plan to have a friend or family member drive you to and from your surgery. After surgery you will be pretty groggy and out of it so you will probably need someone around to look after you.

Make sure you have taken some time off work after a breast enhancement surgery. Your body will need some time to heal and the best way to have a speedy recovery is to take at least a week off to relax. For the first few weeks after surgery you should limit your physical activity so that you don't run the risk of tearing your stitches or picking up an infection.

If you know what to expect and how to properly care for your healing body you should be able to approach surgery and your eventual transformation with confidence.

Herbal Breast Enlargement

Majority of herbal breast enchantment pills - breast enhancement herbs -- contain natural phytoestrogens which are naturally occurring plant estrogens. These plant estrogens are said to stimulate a female body to produce new breast tissue growth.

Herbal breast enhancement pills are considered non-invasive and safer method for women who decide not to go through with plastic surgery and are much less controversial than other alternative methods such as hypnosis or breast pumps. Herbal breast enhancement manufacturers claim to safely stimulate mammarial tissue growth without milk production.

How did the scientists come up with herbs for breast enhancement? Well, it is known that during puberty female body naturally produces estrogens, which help to develop new tissue that makes breasts grow. The hormone that is responsible for the growth is produced by the pituitary gland and it determines the size, shape as well as fullness of woman's breasts.

Herbal breast enhancement ingredients are usually obtained from Saw Palmetto, Wild Yam and Fennel seed. These plants contain the highest levels of natural estrogens as well phyto-nutrients and diosgenin that also promote growth of the tissue. All of these are naturally occurring ingredients and contribute to the hormone activation. They have other benefits as well, for example, the phyto-nutrients are mild and effective and have many other health benefits, such as helping to wash toxins from the system while aiding in healthy breast growth.

It takes a couple of weeks to see the actual results of herbal breast enhancement pills and they don't necessary work for every woman. There are no conclusive studies that confirm that breast enhancement herbs really work. Additionally, it is always a good idea to let your doctor know that you're taking them in case you tend to have an allergic reaction to medication or are simply concerned about safety of certain herbs.