Biomedical subjects
Isabelle Trop
Publications and source records attributed to Isabelle Trop.
Magnetic resonance imaging of the breast: current indications.
Breast magnetic resonance imaging (MRI) plays an increasing role in the management of selected breast cancer patients. MRI is recognized as the most sensitive modality for the detection of invasive breast cancer. Several valuable clinical applications of MRI have emerged for breast cancer detection and diagnosis from clinical investigations. Breast MRI is helpful for women diagnosed with breast cancer who contemplate breast conserving surgery; it provides valuable information on the extent of the disease. MRI can also help assess for residual invasive cancer in patients who have undergone lumpectomy with positive margins at pathology. It is very reliable in differentiating scar tissue from recurrence at the lumpectomy site. MRI is also reliable in finding a breast cancer in women with axillary nodal metastases and unknown primary tumour. MRI can help to monitor the response to chemotherapy. Breast MRI could be a better screening tool than mammography in women with very high risks of developing breast cancer, such as breast cancer gene carriers and patients treated with chest radiation. Other potential uses of MRI include evaluation of the integrity of silicone breast implants and evaluation of the parenchyma in women with silicone gel implants or free injection of silicone gel. However, like any other technique, breast MRI has some drawbacks, including low-to-moderate specificity, high costs, and variability in technique and interpretation. Radiologists must have a clear understanding of valid indications and selection criteria to use this technique appropriately.
Breast procedures guided by magnetic resonance imaging.
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Breast cancer staging: the role of the radiologist.
The role of the breast radiologist has evolved over the past years, with an increasing involvement in patient care. Improvements in diagnostic technology and surgical techniques allow for better preoperative staging and surgeries with decreased morbidity. This article reviews the elements of investigation that are important to the surgeon and oncologist in optimizing care for the newly diagnosed breast cancer patient, with the 6th edition of the TNM classification of the American Joint Committee on Cancer used as a reference.
Randomized controlled trials.
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Fetal thoracic abnormalities: MR imaging.
PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonance (MR) imaging and determine whether MR imaging yields information additional to that obtained with ultrasonography (US). MATERIALS AND METHODS: US and MR imaging data from 83 MR examinations of 74 fetuses with thoracic abnormalities and confirmatory US performed within 1 week before MR imaging were compared with respect to resulting changes in patient counseling and/or care. Lung parenchyma and lesion signal intensities and vascularity, airway, esophagus, and diaphragm appearances were reviewed retrospectively on MR images. Student t tests and analyses of variance were performed. RESULTS: MR imaging yielded information additional to that acquired with US in 28 (38%) of 74 fetuses. The additional findings were confirmed in 19 of the 28 fetuses at postnatal follow-up; no follow-up data were available for the other nine fetuses. Thoracic MR information affected care with regard to six (8%) of 74 fetuses. Mean gestational age of 15 fetuses with lung signal intensity (SI) slightly lower than that of amniotic fluid (28.4 weeks +/- 6.8 [SD]) at T2-weighted MR imaging was significantly older than that of 18 fetuses with intermediate SI (21.3 weeks +/- 4.3) (P <.05). Mean SI of 13 congenital cystic adenomatoid malformations (CCAMs) and/or sequestrations (1.74 +/- 1.05) at T2-weighted MR imaging was significantly higher than that of the normal lungs of 33 fetuses (2.63 +/-.63) (P <.001). Among nine studies in which vessels were visualized in CCAMs and/or sequestrations, six involved a normal vascular branching pattern. Portions of the esophagus were seen in 31 (36%) of 85 fetuses. Nonvisualization of a major airway was not sufficient for diagnosis of pulmonary atresia. Visualization of a portion of the esophagus did not correlate with esophageal atresia. In all except one fetus, who had anhydramnios and pulmonary hypoplasia, and the fetuses with congenital diaphragmatic hernia, at least a portion of the diaphragm was visualized at MR imaging. CONCLUSION: MR imaging yields information additional to that yielded with US in fetuses with thoracic abnormalities.
Interpretation of diagnostic tests: diagnostic accuracy efficacy and effectiveness.
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Estimates of diagnostic accuracy efficacy: how well can this test perform the classification task?
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MR imaging appearance of fetal cerebral ventricular morphology.
PURPOSE: To elucidate further the magnetic resonance (MR) imaging appearance of fetal cerebral ventricles by comparing ultrasonographic (US) and MR images. MATERIALS AND METHODS: A retrospective review of MR and US images was performed for 110 normal fetuses and 94 fetuses with central nervous system abnormalities to assess lateral ventricular morphology as having (a) a normal appearance, (b) mild, disproportionate dilatation of the occipital horns with overall preservation of ventricular morphology, (c) colpocephaly with or without normal orientation of the frontal horns, (d) abnormal orientation of the frontal horns without colpocephaly, (e) an angular appearance, (f) fused frontal horns, (g) global dilation, or (h) a distorted appearance. Ventricular morphology on US and MR images was compared and correlated with reference standard diagnoses. RESULTS: US and MR imaging classifications were concordant in 145 of 188 (77%) examinations. Mild disproportion of occipital horns with respect to frontal horns was seen only on MR images. This ventricular configuration was present in eight of 110 normal fetuses and in 10 of 16 fetuses with isolated mild ventriculomegaly (P <.001). An angular configuration of the lateral ventricles, which is seen in fetuses with neural tube defects (NTDs), was present on review of MR images in 11 fetuses and on US images in one fetus. The ventricles of fetuses with NTDs and angular ventricles (3-12 mm) were significantly smaller than those of fetuses with NTDs and global dilatation of the ventricles (13-25 mm; P <.05). CONCLUSION: Ventricular contours differ with differing diagnoses of central nervous system abnormalities.