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• W4256539426 abstract "To the Editors: We agree with the statement raised by Drs Sardanelli and Fausto. CT application to any disease management needs to be considered carefully, and x-ray exposure should be based on the justification and should be reduced as low as reasonably achievable. In our preliminary study of breast CT lymphography (Surgery 2003;133:170-9), we obtained CT images covering the regions of interest 4 times (once before contrast injection, and at 1, 15, and 30 minutes after injection) in volunteers to evaluate the time course of lymphatic enhancement and to determine optimized image acquisition time for localization of sentinel lymph nodes. However, in our ongoing clinical practice of sentinel node biopsy with CT lymphography in more than 50 patients, we obtain CT images only 2 or 3 times (before contrast injection, and 1 to 3 minutes after injection). We do not obtain additional CT images after confirming the location of SLN on the first postcontrast CT images. Because the sentinel node can be identified on these images, except in several patients, CT images at only 2 times are acquired. The precontrast images are used for the differentiation from nodal calcification deposit and for assessment of presence or absence of lung metastasis and thoracic lymphadenopathy for accurate staging. X-ray exposure dose for a 1-time CT image acquisition, assessed by CTDIW on the CT monitor, ranged from 14.6 to 18 mGy. Furthermore, we also make an effort to reduce x-ray exposure by acceptably minimizing the factor of mAs. There has been no adverse reaction for iodinated contrast injection, and CT-lymphography–guided sentinel node biopsy appears to contribute well to minimal breast surgery for our patients. As shown in our recent preliminary results of breast interstitial magnetic resonance (MR) imaging (Acta Radiologica 2003;44:35-42), MR lymphography can be an alternative to CT lymphography. However, at this time, we believe that accurate localization of sentinel node on MR lymphography needs skill because of the relatively low signal intensity of background soft and bone tissues. Accurately detecting the SLN spot will require some specific devices, if an open MR system is not available. CT lymphography is advantageous for shortening the presurgical examination schedule and hospitalization term for patients in our institute. Although we hope that MR lymphography can be the first choice in some institutes, evaluation of the clinical ability of this technique for accurate localization of sentinel node must be investigated intensively in further study. Advanced CT technology, such as ROI scanning (proposed by Hitachi-Medico Co, Tokyo, Japan), which allows an image acquisition of only the area of region of interest (ie, only target organ) by changing the size of collimation for every scanning directions may reduce the x-ray exposure to the normal contralateral breast." @default.
• W4256539426 created "2022-05-12" @default.
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• W4256539426 date "2003-11-01" @default.
• W4256539426 modified "2023-09-26" @default.
• W4256539426 title "Reply" @default.
• W4256539426 doi "https://doi.org/10.1016/s0039-6060(03)00381-7" @default.
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