Zusammenfassung
Die digitale Vollfeldmammographie hat die konventionelle Film-Folien-Mammographie in den letzten Jahren zunehmend abgelöst. Hohe Quanteneffizienz und eine sehr gute Kontrastauflösung bei optimierter Dosis gewährleisten auch bei Frauen mit dichtem Drüsengewebe eine gute Bildqualität. Die digitale Mammographie bleibt jedoch ein Projektionsverfahren, bei dem durch überlappendes Drüsengewebe die Detektierbarkeit kleiner Veränderungen einschränkt ist. Die Tomosynthese ist ein aus der digitalen Mammographie entwickeltes Verfahren zur Schichtuntersuchung der Brust, die den Einfluss überlappender Strukturen eliminiert und eine 3D-Darstellung der Brust ermöglicht. Eine bogenförmige Bewegung der Röntgenröhre während des Scans erlaubt die Akquisition zahlreicher 2D-Aufnahmen aus unterschiedlichen Winkeln. Nachfolgende Rekonstruktionsalgorithmen im Sinne einer „Shift-and-add“-Methode verbessern die Erkennbarkeit von Details in einer bestimmten Ebene und eliminieren gleichzeitig Wischartefakte durch überlagernde Strukturen. Die Gesamtdosis entspricht dabei der einer herkömmlichen Mammographieaufnahme. Die technische Durchführung – Anzahl der Ebenen, geeignete Anoden/Filterkombinationen, Winkelbereich der Aufnahmen, Wahl der Rekonstruktionsalgorithmen – unterliegt derzeit der Optimierung. Bisherige Studien zum klinischen Stellenwert der Tomosynthese haben Screeningparameter wie die Recall- und Detektionsrate sowie Angaben zur Tumorausdehnung bei histologisch gesichertem Mammakarzinom geprüft. Weiterführende Techniken wie die kontrastmittelunterstützte Tomosynthese werden derzeit entwickelt. Eine besondere Rolle kommt dabei der Dual-energy-Bildgebung zu.
Abstract
In recent years digital full field mammography has increasingly replaced conventional film mammography. High quality imaging is guaranteed by high quantum efficiency and very good contrast resolution with optimized dosing even for women with dense glandular tissue. However, digital mammography remains a projection procedure by which overlapping tissue limits the detectability of subtle alterations. Tomosynthesis is a procedure developed from digital mammography for slice examination of breasts which eliminates the effects of overlapping tissue and allows 3D imaging of breasts. A curved movement of the X-ray tube during scanning allows the acquisition of many 2D images from different angles. Subseqently, reconstruction algorithms employing a shift and add method improve the recognition of details at a defined level and at the same time eliminate smear artefacts due to overlapping structures. The total dose corresponds to that of conventional mammography imaging. The technical procedure, including the number of levels, suitable anodes/filter combinations, angle regions of images and selection of reconstruction algorithms, is presently undergoing optimization. Previous studies on the clinical value of tomosynthesis have examined screening parameters, such as recall rate and detection rate as well as information on tumor extent for histologically proven breast tumors. More advanced techniques, such as contrast medium-enhanced tomosynthesis, are presently under development and dual-energy imaging is of particular importance.
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Hellerhoff, K. Digitale Brusttomosynthese. Radiologe 50, 991–998 (2010). https://doi.org/10.1007/s00117-010-2008-7
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DOI: https://doi.org/10.1007/s00117-010-2008-7
Schlüsselwörter
- Digitale Mammographie
- Brusttomosynthese
- Dual-energy-Mammographie
- Kontrastmittelgestützte Mammographie
- Brustkrebsfrüherkennung