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IMR Press / FBL / Volume 27 / Issue 1 / DOI: 10.31083/j.fbl2701030
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Open Access Original Research
The utility of radiographic assessment of the internal mammary arteries in chest wall irradiated patients
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1 Division of Cardiology, Hoffman Heart and Vascular Institute, Saint Francis Hospital, Hartford, CT 06105, USA
2 Division of Cardiology, University of Connecticut, Farmington, CT 06030, USA
3 Division of Radiology, Saint Francis Hospital, Hartford, CT 06105, USA
4 Division of Radiation-Oncology, Saint Francis Hospital, Hartford, CT 06105, USA
5 Division of Cardiology, VACT Healthcare System, CT 06111, USA
6 Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA

These authors contributed equally.

Front. Biosci. (Landmark Ed) 2022, 27(1), 30; https://doi.org/10.31083/j.fbl2701030
Submitted: 11 September 2021 | Revised: 29 November 2021 | Accepted: 8 December 2021 | Published: 18 January 2022
This is an open access article under the CC BY 4.0 license.
Abstract

Purpose: The internal mammary arteries (IMA’s) are historically recognized to be protected against atherosclerosis. Whether chest wall-irradiation for breast cancer leads to significant IMA damage remains unclear. The utility of computed tomography (CT) and mammography to detect radiation-induced damage to the IMA’s and its branches is not known. The objective of this study is to assess the susceptibility of IMA’s to radiation-induced atherosclerosis, and the utility of CT scan and mammography in the assessment of IMA and its branches. Methods: A retrospective analysis of breast cancer patients who received chest wall-radiotherapy was performed. Patients with CT scans and/or mammograms $\geq$5 years post-radiotherapy were included. Baseline characteristics, coronary artery calcification (CAC), the presence of IMA damage assessed by CT scan, and IMA branch calcifications by mammography were recorded. Results: None of the 66 patients with CT scans post-radiotherapy revealed IMA atherosclerosis. There were 28 (42.4%) patients with CAC, of which four (14.3% of CAC subgroup or 6.1% of the total cohort) had calcifications on either side on mammogram (Chi-square test, p = 0.74). Out of the 222 patients with mammograms, 36 (16.2%) had IMA branch calcifications. Two hundred and ten patients received unilateral radiotherapy, and 27 (12.9%) of these patients had calcifications on the irradiated side, and 26 patients (12.4%) had calcifications on the contralateral side (OR = 1.0). Conclusion: IMA’s do not exhibit signs of radiation-induced atherosclerosis when evaluated by CT scan. In addition, there is no association between radiotherapy for breast cancer and the presence of IMA branch calcification on mammograms.

Keywords
Internal mammary artery
CT scan
Mammogram
Calcification