Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Via Ponzio 34/5, 20133 Milan, Italy.
Eur J Radiol. 2019 Oct;119:108636. doi: 10.1016/j.ejrad.2019.08.005. Epub 2019 Aug 11.
To highlight the importance of quantitative breast arterial calcifications (BAC) assessment for an effective stratification of cardiovascular (CV) risk in women, for whom current preventive strategies are inadequate. BAC, easily detectable on mammograms, are associated with CV disease and represent a potential imaging biomarker for CV disease prevention in women.
We summarized the available evidence on this topic.
Age, parity, diabetes, and hyperlipidemia were found to positively correlate with BAC. Women with BAC have a higher CV risk than those without BAC: the relative risk was reported to be 1.4 for transient ischemic attack/stroke, 1.5 for thrombosis, 1.8 for myocardial infarction; the reported hazard ratio was 1.32 for coronary artery disease (CAD), 1.52 for heart failure, 1.29 for CV death, 1.44 for death from CAD. However, BAC do not alarm radiologists; when reported, they are commonly mentioned as "present", not impacting on CV decision-making. Of 18 published studies, 9 reported only presence/absence of BAC, 4 used a semi-quantitative scale, and 5 a continuous scale (with manual, automatic or semiautomatic segmentation). Various appearance, topological complexity, and vessels overlap make BAC quantification difficult to standardize. Nevertheless, machine learning approaches showed promising results in BAC quantification on mammograms.
There is a strong rationale for mammography to become a dual test for breast cancer screening and CV disease prevention. However, robust and automated quantification methods are needed for a deeper insight on the association between BAC and CV disease, to stratifying CV risk and define personalized preventive actions.
强调定量乳腺动脉钙化（BAC）评估对于女性心血管（CV）风险分层的重要性，因为目前针对女性的预防策略还不够充分。BAC 可在乳房 X 光片中轻易检测到，与 CV 疾病相关，代表了女性 CV 疾病预防的一种潜在影像学生物标志物。
我们总结了这个主题的现有证据。
年龄、产次、糖尿病和高脂血症与 BAC 呈正相关。有 BAC 的女性比没有 BAC 的女性 CV 风险更高：报道的相对风险为短暂性脑缺血发作/中风 1.4，血栓形成 1.5，心肌梗死 1.8；报道的冠心病（CAD）风险比为 1.32，心力衰竭 1.52，CV 死亡 1.29，CAD 死亡 1.44。然而，BAC 并没有引起放射科医生的警惕；当报告时，它们通常被描述为“存在”，不会影响 CV 决策。在已发表的 18 项研究中，有 9 项仅报告了 BAC 的存在/不存在，4 项使用了半定量量表，5 项使用了连续量表（手动、自动或半自动分割）。BAC 的各种外观、拓扑复杂性和血管重叠使得 BAC 的定量难以标准化。然而，机器学习方法在乳房 X 光片上的 BAC 定量方面显示出了有前景的结果。
强烈建议将乳房 X 光检查作为乳腺癌筛查和 CV 疾病预防的双重检测。然而，需要稳健和自动化的定量方法，以更深入地了解 BAC 与 CV 疾病之间的关联，对 CV 风险进行分层，并确定个性化的预防措施。
