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Advisor(s)
Abstract(s)
O cancro da mama é, atualmente, o cancro mais frequente nas mulheres e a maior causa de morte – relacionada a cancro - nas mulheres em todo o mundo. A ressonância magnética tem vindo a ter um papel crescente no que diz respeito a rastreio de cancro em mama denso. O exame de ressonância magnética (RM) fornece uma avaliação tridimensional de alta sensibilidade, elevado contraste para tecidos moles e elevada especificidade proporcionada por imagens de RM Multiparamétrica. Para gerir os custos associados ao rastreio do cancro de mama, o uso de protocolos abreviados de RM pode ser benéfico. Realizou-se uma revisão sistemática da literatura sobre o papel e a potencialidade da ressonância magnética no rastreio do cancro da mama, numa abordagem de protocolos abreviados (AP), e relatamos os resultados de acurácia diagnóstica para diferentes sequências de imagem por RM e para diferentes intensidades de campo magnético: 1,5T e 3T. Forest plot e curvas características de operação do recetor (ROC) foram realizadas. O risco de viés e a aplicabilidade no nível do estudo foram avaliados. Trinta estudos foram identificados para a revisão sistemática. Os valores de sensibilidade e fração de falsos positivos foram, respectivamente, para CP de 94.7% e 18.5% para AP de 88.2% e de 14.9%; para Utrafast + AP de 90.7% e de 29.9%; para AP e STIR -combinados RM de 89% e de 9%; para AP + DWI de 100% e de 5%; para AP de DWI, 83.9 % e de 6%%. Para estudos de ressonância magnética realizados com intensidade de campo de 1,5T, obtivemos uma sensibilidade e fração de falsos positivos de 92.6% e de 20.6%, respetivamente. Enquanto os valores de sensibilidade e a taxa de falso positivos da combinação de vários protocolos para estudos de ressonância magnética realizados em 3T foram de 96% e de 9.5%, respetivamente. Nenhum estudo foi excluído da análise com base na avaliação de qualidade. Os resultados deste estudo, apontam para o protocolo de AP+ DWI como aquele que forneceu maior valor de sensibilidade e menor valor de fração de falsos positivos. Relativamente à intensidade de campo magnético, por ter maior resolução sinal ruído, os protocolos realizados em equipamentos com campos de 3T, relataram maior precisão diagnóstica (alto valor de sensibilidade e baixo valor de fração de falsos positivos).
ABSTRACT - Breast cancer is currently the most common cancer in women and the leading cause of death in women from cancer worldwide. Magnetic resonance imaging is playing an increasing role in breast cancer screening. Magnetic resonance imaging (MRI) offers a three-dimensional assessment with high sensitivity, high contrast for soft tissues, and high specificity provided by Multiparametric MR images. To manage the costs associated with breast cancer screening, the use of abbreviated MRI protocols can be beneficial. We conducted a systematic review of the literature on the role and potential of magnetic resonance imaging in breast cancer screening, using an abbreviated protocol (AP) approach, and we reported the results of diagnostic accuracy for different MR imaging sequences, or combinations. of sequences, and for different magnetic field strengths: 1.5T and 3T. Forest plot and receiver operating characteristic curves (ROC) were performed. Visibility risk and applicability at the study level were adopted. Thirty studies were identified for a systematic review. The values of sensitivity and fraction of false positives were, respectively, for CP of 94.7% and 18.5% for AP of 88.2% and 14.9%; for Utrafast + AP 90.7% and 29.9%; for AP and STIR -combined RM of 89% and 9%; for AP + DWI of 100% and 5%; for AP of DWI, 83.9% and 6%%. For magnetic resonance studies performed with a field strength of 1.5T, we obtained sensitivity and false-positive fractions of 92.6% and 20.6%, respectively. While the sensitivity values and the false positive rate of the combination of multiple protocols for MRI studies performed in 3T were 96% and 9.5%, respectively. No studies were excluded from the analysis based on quality assessment. The study results point to the AP + DWI protocol as the one that provided the highest sensitivity value and the lowest false positive fraction value. Regarding the magnetic field intensity, due to its higher signal-noise resolution, the protocols performed in equipment with 3T fields reported greater diagnostic accuracy (high sensitivity value and low false-positive fraction value).
ABSTRACT - Breast cancer is currently the most common cancer in women and the leading cause of death in women from cancer worldwide. Magnetic resonance imaging is playing an increasing role in breast cancer screening. Magnetic resonance imaging (MRI) offers a three-dimensional assessment with high sensitivity, high contrast for soft tissues, and high specificity provided by Multiparametric MR images. To manage the costs associated with breast cancer screening, the use of abbreviated MRI protocols can be beneficial. We conducted a systematic review of the literature on the role and potential of magnetic resonance imaging in breast cancer screening, using an abbreviated protocol (AP) approach, and we reported the results of diagnostic accuracy for different MR imaging sequences, or combinations. of sequences, and for different magnetic field strengths: 1.5T and 3T. Forest plot and receiver operating characteristic curves (ROC) were performed. Visibility risk and applicability at the study level were adopted. Thirty studies were identified for a systematic review. The values of sensitivity and fraction of false positives were, respectively, for CP of 94.7% and 18.5% for AP of 88.2% and 14.9%; for Utrafast + AP 90.7% and 29.9%; for AP and STIR -combined RM of 89% and 9%; for AP + DWI of 100% and 5%; for AP of DWI, 83.9% and 6%%. For magnetic resonance studies performed with a field strength of 1.5T, we obtained sensitivity and false-positive fractions of 92.6% and 20.6%, respectively. While the sensitivity values and the false positive rate of the combination of multiple protocols for MRI studies performed in 3T were 96% and 9.5%, respectively. No studies were excluded from the analysis based on quality assessment. The study results point to the AP + DWI protocol as the one that provided the highest sensitivity value and the lowest false positive fraction value. Regarding the magnetic field intensity, due to its higher signal-noise resolution, the protocols performed in equipment with 3T fields reported greater diagnostic accuracy (high sensitivity value and low false-positive fraction value).
Description
Mestrado em Radiações Aplicadas às Tecnologias da Saúde - Ramo de especialização: Ressonância Magnética
Keywords
Ressonância magnética Cancro da mama Protocolos abreviados Difusão Espectroscopia Contraste dinâmico Magnetic resonance imaging Breast cancer Abbreviated protocols Diffusion-weighted imaging Spectroscopy Dynamic contrast enhanced
Citation
Pereira IC. Ressonância magnética multiparamétrica da mama: protocolos para rastreio mamário (revisão sistemática) [dissertação]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2021.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa