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Japanese Journal of Clinical Oncology Advance Access originally published online on August 4, 2009
Japanese Journal of Clinical Oncology 2009 39(9):552-559; doi:10.1093/jjco/hyp087
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© The Author (2009). Published by Oxford University Press. All rights reserved

Fusion of MRI and Sonography Image for Breast Cancer Evaluation Using Real-time Virtual Sonography with Magnetic Navigation: First Experience

Shogo Nakano1, Miwa Yoshida1, Kimihito Fujii1, Kyoko Yorozuya1, Yukako Mouri1, Junko Kousaka1, Takashi Fukutomi1, Junko Kimura2, Tsuneo Ishiguchi2, Kazuko Ohno3, Takao Mizumoto4 and Michiko Harao5

1 Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Aichi
2 Department of Radiology, Aichi Medical University, Aichi
3 Department of Radiological Technology, Kyoto College of Medical Science, Kyoto
4 Department of Surgery, Health Insurance Hitoyoshi General Hospital, Kumamoto
5 Department of Surgery, Tochigi Cancer Center, Tochigi, Japan

For reprints and all correspondence: Shogo Nakano, Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 21 Nagakute-cho, Aichi-gun, Aichi 480-1195, Japan. E-mail: snakano1{at}aichi-med-u.ac.jp

Received May 9, 2009; accepted July 6, 2009

Objective: We recently developed a real-time virtual sonography (RVS) system that enables simultaneous display of both sonography and magnetic resonance imaging (MRI) cutaway images of the same site in real time. The aim of this study was to evaluate the role of RVS in the management of enhancing lesions visualized with MRI.

Methods: Between June 2006 and April 2007, 65 patients underwent MRI for staging of known breast cancer at our hospital. All patients were examined using mammography, sonography, MRI and RVS before surgical resection. Results were correlated with histopathologic findings. MRI was obtained on a 1.5 T imager, with the patient in the supine position using a flexible body surface coil. Detection rate was determined for index tumors and incidental enhancing lesions (IELs), with or without RVS.

Results: Overall sensitivity for detecting index tumors was 85% (55/65) for mammography, 91% (59/65) for sonography, 97% (63/65) for MRI and 98% (64/65) for RVS. Notably, in one instance in which the cancer was not seen on MRI, RVS detected it with the supplementation of sonography. IELs were found in 26% (17/65) of the patients. Of 23 IELs that were detected by MRI, 30% (7/23) of IELs could be identified on repeated sonography alone, but 83% (19/23) of them were identified using the RVS system (P = 0.001). The RVS system was able to correctly project enhanced MRI information onto a body surface, as we checked sonography form images.

Conclusions: Our results suggest that the RVS system can identify enhancing breast lesions with excellent accuracy.

Key Words: real-time virtual sonography • MRI • sonography • breast cancer • incidental enhancing lesion


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