Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
Maturitas. 2023 Jan;167:75-81. doi: 10.1016/j.maturitas.2022.10.001. Epub 2022 Oct 20.
Breast density (BD) and breast arterial calcifications (BAC) can expand the role of mammography. In premenopause, BD is related to body fat composition: breast adipose tissue and total volume are potential indicators of fat storage in visceral depots, associated with higher risk of cardiovascular disease (CVD). Women with fatty breast have an increased likelihood of hypercholesterolemia. Women without cardiometabolic diseases with higher BD have a lower risk of diabetes mellitus, hypertension, chest pain, and peripheral vascular disease, while those with lower BD are at increased risk of cardiometabolic diseases. BAC, the expression of Monckeberg sclerosis, are associated with CVD risk. Their prevalence, 13 % overall, rises after menopause and is reduced in women aged over 65 receiving hormonal replacement therapy. Due to their distinct pathogenesis, BAC are associated with hypertension but not with other cardiovascular risk factors. Women with BAC have an increased risk of acute myocardial infarction, ischemic stroke, and CVD death; furthermore, moderate to severe BAC load is associated with coronary artery disease. The clinical use of BAC assessment is limited by their time-consuming manual/visual quantification, an issue possibly solved by artificial intelligence-based approaches addressing BAC complex topology as well as their large spectrum of extent and x-ray attenuations. A link between BD, BAC, and osteoporosis has been reported, but data are still inconclusive. Systematic, standardised reporting of BD and BAC should be encouraged.
乳腺密度（BD）和乳腺动脉钙化（BAC）可以扩展乳房 X 线摄影的作用。在绝经前，BD 与体脂组成有关：乳腺脂肪组织和总容积是内脏脂肪储存的潜在指标，与心血管疾病（CVD）风险增加相关。乳腺脂肪含量高的女性更有可能患有高胆固醇血症。患有代谢性心血管疾病的女性，BD 较高，患糖尿病、高血压、胸痛和外周血管疾病的风险较低，而 BD 较低的女性患代谢性心血管疾病的风险较高。BAC 是 Monckeberg 硬化症的表现，与 CVD 风险相关。其总体患病率为 13%，绝经后升高，在接受激素替代治疗的 65 岁以上女性中降低。由于其独特的发病机制，BAC 与高血压有关，但与其他心血管危险因素无关。患有 BAC 的女性急性心肌梗死、缺血性中风和 CVD 死亡的风险增加；此外，中度至重度 BAC 负荷与冠状动脉疾病相关。由于其耗时的手动/视觉量化，BAC 评估的临床应用受到限制，这一问题可能通过基于人工智能的方法解决，这些方法可以解决 BAC 复杂的拓扑结构及其广泛的程度和 X 射线衰减。已经有报道称 BD、BAC 和骨质疏松症之间存在关联，但数据仍不确定。应鼓励系统、标准化报告 BD 和 BAC。
