References

Breast J 2003 Jan-Feb;9(1):13-8 Related Articles, Links
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Invasive lobular carcinoma: spectrum of enhancement and morphology on magnetic resonance imaging.

Yeh ED, Slanetz PJ, Edmister WB, Talele A, Monticciolo D, Kopans DB.

Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. eyeh@partners.org

Invasive lobular carcinoma (ILC) may be a difficult tumor to detect early by physical examination, mammography, or ultrasound. We undertook this study to describe the spectrum of gadolinium enhancement and morphologic features of ILC on magnetic resonance imaging (MRI). Nineteen patients with ILC who presented with a palpable mass, a mammographically visible abnormality, or an unknown primary underwent preoperative MRI of both breasts using a T1-weighted high-resolution gradient echo sequence (pre- and postcontrast), and an echoplanar sequence during the administration of gadolinium. Using a quantitative measure of gadolinium uptake over time, called the extraction flow (EF) product, and a normal tissue threshold EF level of 25 or less, enhancement for 15 of the 19 cancers was characterized. By consensus, three radiologists categorized the morphologic features of the lesions. For the 15 cases of ILC that had echoplanar data, analysis showed peak EFs ranging between 25 and 120, and the majority showed EFs in the 30s. A substantial portion of two tumors enhanced in a similar fashion to normal breast tissue, with EFs in the low 20s. Morphologically MRI showed a focal mass in eight cases, regional enhancement in five, segmental enhancement in one, segmental enhancement with multiple small nodules in one, a mixture of a focal mass and regional enhancement in one, diffuse enhancement in one, multiple small nodules in one, and bilateral disease in one. Of the focal masses, seven were irregular in shape and one was round; six had ill-defined margins and two had spiculated margins. All eight enhanced heterogeneously. Four cases had multifocal disease and one case had unsuspected contralateral disease discovered only on MRI. MRI using a combination of morphology and a quantitative measure of gadolinium uptake was able to detect the majority of cases of ILC. However, there was a variable morphologic appearance and contrast enhancement pattern on MRI. A few lesions were difficult to distinguish from normal tissue. This suggests that some cases of ILC may be difficult to detect on MRI.

PMID: 12558665 [PubMed - in process]
 
 
 
AJR Am J Roentgenol 2002 May;178(5):1227-32 Related Articles, Links
 
MR imaging features of infiltrating lobular carcinoma of the breast: histopathologic correlation.

Qayyum A, Birdwell RL, Daniel BL, Nowels KW, Jeffrey SS, Agoston TA, Herfkens RJ.

Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA.

OBJECTIVE: Our study aimed to correlate the dynamic contrast-enhanced MR appearance of infiltrating lobular carcinoma of the breast with histopathologic findings. MATERIALS AND METHODS: We retrospectively reviewed the high-resolution, fat-suppressed and dynamic contrast-enhanced MR images of 13 of 20 women diagnosed with pathologically proven infiltrating lobular carcinoma of the breast. Twelve of the 13 women presented with breast symptoms and underwent mammography. Five of the women also had breast sonography. MR imaging was performed for evaluation of disease extent before the patients underwent modified radical mastectomy (n = 11) or lumpectomy (n = 2). Three experienced radiologists reviewed the MR scans. The tumor pattern types described on imaging were correlated with a detailed analysis of the pathology. RESULTS: We found three patterns of infiltrating lobular carcinoma on MR imaging. The tumor pattern on imaging correlated with pathologic tumor morphology. We found the following patterns of infiltrating lobular carcinoma: a solitary mass with irregular margins (n = 4) that corresponded to the same appearance at pathology; multiple lesions, either connected by enhancing strands (n = 6) or separated by nonenhancing intervening tissue (n = 2), that correlated with the pathologic appearance of noncontiguous tumor foci, with malignant cells streaming in single-file fashion in the breast stroma or small tumor aggregates separated by normal tissue; and enhancing septa only, which were correlated with the histopathologic appearance of tumor cells streaming in the breast stroma (n = 1). CONCLUSION: Infiltrating lobular carcinoma may be detected on MR imaging as solitary or multiple lesions that correspond to tumor morphology on pathologic examination. The appearance of multiple lesions or of enhancing fibroglandular breast elements on MR imaging is suggestive of infiltrating lobular carcinoma.

PMID: 11959737 [PubMed - indexed for MEDLINE]

 

Radiol Clin North Am 2002 May;40(3):443-66 Related Articles, Links

Breast cancer imaging with MRI.

Morris EA.

Weill Medical College, Cornell University, New York, NY 10021, USA. morrise@mskcc.org

Breast MRI is an emerging technology that may revolutionize our management of women with known or suspected breast cancer. MRI examinations should be interpreted with an awareness of the pitfalls and artifacts that can affect on image evaluation. Development of an MRI lexicon will assist by providing standardized terminology that may improve our understanding of the positive predictive value of different MRI features. To date, breast MRI has proven most useful in patients with proven breast cancer to assess for multifocal/multicentric disease, chest wall involvement, chemotherapy response, or tumor recurrence or to identify the primary site in patients with occult breast cancer. Further work is necessary to assess the utility of breast MRI in other settings, such as screening of women at high risk for breast cancer.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 12117186 [PubMed - indexed for MEDLINE]

 

Semin Roentgenol 2001 Jul;36(3):238-49 Related Articles, Books, LinkOut

Illustrated breast MR lexicon.

Morris EA.

Department of Radiology, Weill Medical College of Cornell University and Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.

A group of international breast MRI experts is currently working on a definitive lexicon for breast MRI that will incorporate both morphologic and kinetic features of lesions identified on breast MRI. The work to develop the lexicon is supported currently by the American College of Radiology (ACR). This article is aimed at introducing this material and should not be used as a definitive guide as the breast MRI lexicon is a work in progress. It is hoped that radiologists will use the terms and concepts presented here as a template to which future lexicon terminology can be added.
 
PMID: 11475070 [PubMed - indexed for MEDLINE]
 
J Magn Reson Imaging 2001 Jun;13(6):889-95 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/82002645/START
Development, standardization, and testing of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging studies.

Ikeda DM, Hylton NM, Kinkel K, Hochman MG, Kuhl CK, Kaiser WA, Weinreb JC, Smazal SF, Degani H, Viehweg P, Barclay J, Schnall MD.

Department of Radiology at Stanford University Medical School, 300 Pasteur Drive, Stanford, California 94105-5105, USA. dikeda@stanford.edu

The purpose of this study was to develop, standardize, and test reproducibility of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging (MRI) examinations. To standardize breast MRI lesion description and reporting, seven radiologists with extensive breast MRI experience developed consensus on technical detail, clinical history, and terminology reporting to describe kinetic and architectural features of lesions detected on contrast-enhanced breast MR images. This lexicon adapted American College of Radiology Breast Imaging and Data Reporting System terminology for breast MRI reporting, including recommendations for reporting clinical history, technical parameters for breast MRI, descriptions for general breast composition, morphologic and kinetic characteristics of mass lesions or regions of abnormal enhancement, and overall impression and management recommendations. To test morphology reproducibility, seven radiologists assessed morphology characteristics of 85 contrast-enhanced breast MRI studies. Data from each independent reader were used to compute weighted and unweighted kappa (kappa) statistics for interobserver agreement among readers. The MR lexicon differentiates two lesion types, mass and non-mass-like enhancement based on morphology and geographical distribution, with descriptors of shape, margin, and internal enhancement. Lexicon testing showed substantial agreement for breast density (kappa = 0.63) and moderate agreement for lesion type (kappa = 0.57), mass margins (kappa = 0.55), and mass shape (kappa = 0.42). Agreement was fair for internal enhancement characteristics. Unweighted kappa statistics showed highest agreement for the terms dense in the breast composition category, mass in lesion type, spiculated and smooth in mass margins, irregular in mass shape, and both dark septations and rim enhancement for internal enhancement characteristics within a mass. The newly developed breast MR lexicon demonstrated moderate interobserver agreement. While breast density and lesion type appear reproducible, other terms require further refinement and testing to lead to a uniform standard language and reporting system for breast MRI. J. Magn. Reson. Imaging 2001;13:889-895. Copyright 2001 Wiley-Liss, Inc.

PMID: 11382949 [PubMed - indexed for MEDLINE]

 

 
J Magn Reson Imaging 2001 Jun;13(6):821-9 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/82002384/START
Challenges to interpretation of breast MRI.

Kinkel K, Hylton NM.

Department of Radiology, University of California-San Francisco, San Francisco, California, USA. Karen.Kinkel@hcuge.ch

This review describes the current knowledge and challenges of lesion interpretation with MRI of the breast according to different image interpretation strategies. Particular emphasis is given to patient- and tumor-related factors that influence image interpretation. The impacts of the menstrual cycle, prior surgery, radiation therapy, and chemotherapy are summarized. Particular enhancement features of ductal carcinoma in situ (DCIS) or invasive lobular carcinoma are described. Finally, an adequate diagnosis at MRI of the breast should take into account the results of the patient's history, physical examination, and all imaging tests performed before MRI. J. Magn. Reson. Imaging 2001;13:821-829. Copyright 2001 Wiley-Liss, Inc.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 11382939 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 2001 May;176(5):1249-54 Related Articles, Books, LinkOut

Incidental enhancing lesions found on MR imaging of the breast.

Brown J, Smith RC, Lee CH.

Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06520, USA.

OBJECTIVE: This study was undertaken to determine the frequency and significance of foci of enhancement having no corresponding mammographic or clinical abnormality that are encountered on MR imaging of the breast performed to evaluate mammograms with equivocal findings. MATERIALS AND METHODS: Reports from MR examinations of 103 patients who underwent MR imaging of the breast to evaluate questionable mammographic findings were retrospectively reviewed. We identified cases that had focal enhancing lesions without a corresponding mammographic or palpable abnormality. Clinical history, mammograms, MR images, and follow-up information were reviewed. RESULTS: Of the 103 patients, 30 (29%) had incidental foci of enhancement. These women were significantly younger, more often premenopausal, and more likely to have dense breasts than those who did not have incidental foci. Tissue confirmation of the incidental foci was available for seven patients, mammographic follow-up was available for a mean interval of 22 months for 22 patients, and no follow-up was available for one. Cancer at the incidental sites was diagnosed in one of the 30 patients with multiple foci. She was also shown to have cancer at the site originally questioned mammographically (index site). None of the remaining patients has had a diagnosis of malignancy at the incidental sites. CONCLUSION: Incidental enhancing foci are common in women undergoing breast MR imaging for questionable findings on mammography, occurring in 29% of our patients. Our results suggest that unless malignancy is diagnosed elsewhere in the breast, these incidental foci are unlikely to be malignant.

PMID: 11312189 [PubMed - indexed for MEDLINE]

 

 
Eur Radiol 2001;11(9):1651-8 Related Articles, Links
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MR imaging of the skin and nipple of the breast: differentiation between tumour recurrence and post-treatment change.

Ralleigh G, Walker AE, Hall-Craggs MA, Lakhani SR, Saunders C.

Department of Radiology, The Middlesex Hospital, Mortimer Street, London WIT 3AA, UK.

Contrast-enhanced MR imaging of the breast has been found to be valuable in the assessment of local recurrence of previously treated breast cancer. We looked specifically at the appearances of the skin and nipple of the treated breast in order to describe the appearances of post-treatment change and recurrence in this region. Thirty-nine women treated for breast cancer had MR imaging of one or both breasts reviewed retrospectively with particular attention to the nipple and skin. The skin and chest wall were assessed for patients with mastectomies. All available histology of the skin and/or nipple, obtained following MR imaging, was reviewed. In patients who did not undergo surgery following MR imaging, clinical follow-up was obtained. Six of 39 cases had nodular enhancing areas seen on MR imaging, which correlated with histology demonstrating tumour recurrence within the skin and/or nipple. Of the remaining 33 patients, changes of linear or diffuse enhancement were seen in the skin and/or nipple of 15 patients. These changes were shown to be benign post-treatment changes at surgery/biopsy in 4 cases or by clinical follow-up in the remainder. In this article we demonstrate differing patterns of contrast enhancement within the skin and nipple in recurrent breast carcinoma vs. post-treatment changes. This suggests that contrast-enhanced MR imaging of the breast may be a useful tool in differentiating tumour recurrence from post-treatment changes within the skin and nipple.

PMID: 11511886 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 2001 Feb;176(2):399-406 Related Articles, Books, LinkOut

MR imaging of the breast in patients with invasive lobular carcinoma.

Weinstein SP, Orel SG, Heller R, Reynolds C, Czerniecki B, Solin LJ, Schnall M.

Department of Radiology, The University of Pennsylvania Medical Center, 1 Silverstein Bldg., 3400 Spruce St., Philadelphia, PA 19104, USA.

OBJECTIVE: Our objective was to assess the usefulness of MR imaging in patients diagnosed with invasive lobular carcinoma of the breast. MATERIALS AND METHODS: Between July 1993 and September 1999, 32 women (33 cases) diagnosed with pure invasive lobular carcinoma of the breast underwent contrast-enhanced MR imaging examination. One woman was excluded because of lack of follow-up. Correlation was made between the mammographic and sonographic findings, the MR imaging findings, and the final pathology results for the remaining 32 cases. RESULTS: In 18 women who did not undergo excisional biopsy before the MR imaging, MR imaging showed more extensive tumor burden or the detection of the primary lesion that was occult on conventional imaging in seven (38.9%) of 18 women. In nine (50%) of 18 women, MR imaging performed equally as well as mammography and sonography. In one case (5.6%), MR imaging and mammography underestimated disease extent. In another patient (5.6%), MR imaging overestimated tumor burden, although mammography failed to show the cancer. In 14 patients who had excisional biopsy before the MR imaging, residual tumor was shown in eight women (57.1%) with extensive tumor or additional separate foci in five of the eight patients. In two cases (14.3%) that were interpreted as equivocal, residual tumor was shown in both cases on reexcision. In three cases (21.4%), the MR imaging was interpreted as negative, but microscopic tumor was shown around seroma on reexcision. False-positive enhancement was seen in one case (7.1%). CONCLUSION: MR imaging showed more extensive tumor than conventional imaging and affected the clinical management in 16 (50%) of 32 patients with invasive lobular carcinoma.

PMID: 11159081 [PubMed - indexed for MEDLINE]

 

 
J Magn Reson Imaging 2000 Dec;12(6):975-83 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/76500638/START
Magnetic resonance imaging of breast cancer: clinical indications and breast MRI reporting system.

Ikeda DM, Baker DR, Daniel BL.

Department of Radiology, Stanford University Medical School, Stanford, California 94105-5105, USA. dikeda@stanford.edu

Magnetic resonance imaging (MRI) is well suited to the investigation of breast cancer by virtue of its noninvasive nature and its multiplanar imaging abilities. MRI investigations showed high sensitivity but modest specificity for breast cancer detection and diagnosis. Most early studies tested the ability of MRI to evaluate and diagnose findings in the breast discovered by other imaging tests or by breast physical examination (1-4). When it was discovered that MRI identified small breast cancers undetected by mammography or breast ultrasound, MRI was used to estimate breast cancer extent in known cancer cases for surgical planning (5,6). These investigations led to the use of MRI in a multitude of breast imaging applications, raising further questions about the use of MRI in everyday practice: What are the indications for breast MRI in general practice? What is its role in light of other imaging tests? What are its benefits and limitations in each setting? How do I report these studies? The purpose of this article is to review the clinical background regarding indications for the use of MRI and relevant cases in which MRI can impact patient management in breast disease, and to describe new developments in reporting breast MRI studies. J. Magn. Reson. Imaging 2000;12:975-983. Copyright 2000 Wiley-Liss, Inc.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 11105039 [PubMed - indexed for MEDLINE]

 

 
J Magn Reson Imaging 2000 Dec;12(6):965-74 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/76500663/START
Dynamic image interpretation of MRI of the breast.

Kuhl CK, Schild HH.

Department of Radiology, University of Bonn, Bonn, Germany. kuhl@uni-bonn.de

Dynamic breast MRI provides information on both lesion cross-sectional morphology and functional lesion features such as vascularity/perfusion and vessel permeability. This review gives an overview of the historical background of dynamic contrast-enhanced breast MRI. It explains the technique's pathophysiological basis, describes the various technical approaches that have been pursued and the corresponding interpretation guidelines that have been proposed (including their respective diagnostic accuracies), and presents established and evolving clinical applications of the "dynamic approach" to breast MRI. J. Magn. Reson. Imaging 2000;12:965-974. Copyright 2000 Wiley-Liss, Inc.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 11105038 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 2000 Jul;175(1):35-43 Related Articles, Books, LinkOut

Dynamic high-spatial-resolution MR imaging of suspicious breast lesions: diagnostic criteria and interobserver variability.

Kinkel K, Helbich TH, Esserman LJ, Barclay J, Schwerin EH, Sickles EA, Hylton NM.

Division of Radiology, Magnetic Resonance Science Center, University of California, San Francisco 94143-1290, USA.

OBJECTIVE: Our study was undertaken to develop diagnostic rules and to assess the reproducibility of dynamic and morphologic parameters for the characterization of suspicious breast lesions using dynamic high-spatial-resolution MR imaging. MATERIALS AND METHODS: Fifty-seven patients with suspicious mammographic or palpable findings underwent preoperative contrast-enhanced MR imaging of the breast using a three-time-point method of acquisition. Each lesion was prospectively analyzed by two independent radiologists for morphologic and visual dynamic enhancement characteristics. A classification and regression tree was used to examine the optimal order, cutoff points, and combination of imaging parameters to build a diagnostic rule separating benign from malignant lesions using histopathology findings as the standard of reference. Kappa statistics were used to determine observer variability. RESULTS: Among 23 benign and 34 malignant lesions (12 invasive, three ductal carcinoma in situ, and 19 mixed cancer), margin morphology (p = 0.001) and enhancement pattern (p = 0.001) were the most significant MR imaging findings for lesion characterization. Focal mass lesions were classified as malignant when spiculated margins or both the washout enhancement pattern and "nonsmooth" margins were present. Interobserver agreement was almost perfect for washout pattern and substantial for margin assessment. In the limited population tested retrospectively, the diagnostic rule yielded a sensitivity and positive predictive value of 97% each and a specificity and negative predictive value of 96% each. CONCLUSION: The washout enhancement pattern combined with lesion margin assessment on dynamic contrast-enhanced high-resolution MR imaging of the breast allows reproducible lesion characterization and may be a highly specific diagnostic tool.

PMID: 10882243 [PubMed - indexed for MEDLINE]

 

 
Br J Radiol 2000 Jun;73(870):665-71 Related Articles, Books, LinkOut
  
Pitfalls of breast MRI.

Coulthard A, Potterton AJ.

Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.

This article reviews some of the common pitfalls associated with breast MRI. Pitfalls can be broadly considered as "technical" (relating to patient factors or machine factors, which can influence image interpretation) or "non-technical" (relating to misinterpretation of imaging findings in the absence of technical problems). Awareness of potential pitfalls is important if MRI is to maximize its potential in breast imaging.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 10911793 [PubMed - indexed for MEDLINE]

 

 
J Magn Reson Imaging 2000 Jun;11(6):601-6 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/72504064/START
Correlation of high-resolution breast MR imaging with histopathology; validation of a technique.

Holland AE, Hendrick RE, Jin H, Russ PD, Barentsz JO, Holland R.

Department of Radiology, University Hospital Nijmegen, 6500 HB Nijmegen, The Netherlands. agnes_holland@hotmail.com

A high-resolution three-dimensional surface gradient coil set was used to obtain magnetic resonance (MR) images of breast specimens, using a gradient-echo pulse sequence (TR/TE 1000/8 msec, flip angle 75 degrees), with 117 micrometer in-plane resolution and 1 mm slice thickness. Breast tissues were obtained from one autopsy and three surgical specimens. High-resolution breast MR images and histopathology sections (7 micrometer thickness) were acquired in the same anatomical plane. Radiographs were acquired of the sliced specimens (approximately 5 mm thick) so that images from all three methods could be correlated. It was found that in vitro high-resolution breast MRI correlated well with low-resolution microscopic histology, demonstrating normal anatomy (lobules, ducts, connective tissue strands, blood vessels) and pathology (tumor content, margins, and presence of microcalcifications) of the breast more clearly than conventional pre-gadolinium breast MRI. High-resolution breast MRI may improve specificity, when added to a conventional breast MRI protocol. Copyright 2000 Wiley-Liss, Inc.

PMID: 10862058 [PubMed - indexed for MEDLINE]

 

 
Radiology 1999 Aug;212(2):543-9 Related Articles, Books, LinkOut
Click here to read
Breast MR imaging in patients with axillary node metastases and unknown primary malignancy.

Orel SG, Weinstein SP, Schnall MD, Reynolds CA, Schuchter LM, Fraker DL, Solin LJ.

Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA. orel@oasis.rad.upenn.edu

PURPOSE: To assess the usefulness of magnetic resonance (MR) imaging of the breast in patients with malignant axillary adenopathy and unknown primary malignancy. MATERIALS AND METHODS: Between October 1993 and December 1997, 38 women with malignant axillary adenopathy and negative mammographic and physical examination findings underwent contrast material-enhanced MR imaging. Sixteen patients were excluded due to axillary tail cancer (n = 7), lack of follow-up (n = 4), second primary malignancy (n = 3), or chemotherapy before MR imaging (n = 2). The study population comprised the remaining 22 patients. Histopathologic findings were available in 20 patients; follow-up MR imaging findings were available in two patients. RESULTS: MR imaging depicted a primary breast cancer in 19 patients (86%; identified at excisional biopsy or mastectomy in 17, resolved on follow-up MR images during treatment in two). MR imaging depicted 4-30-mm cancers (mean, 17 mm), which correlated closely with histopathologic size. Two patients (9%) had false-negative findings: (a) One had a 2-mm invasive ductal carcinoma, and (b) one had 17- and 20-mm invasive ductal carcinomas. Of the 19 patients, 11 underwent mastectomy, seven underwent breast-conservation therapy, and one did not undergo a surgical procedure. CONCLUSION: MR imaging is very sensitive for the detection of mammographically and clinically occult breast cancer in patients with malignant axillary adenopathy. In these patients, MR imaging offers potential not only for cancer detection but also for staging the cancer within the breast, which may be useful for treatment planning.

PMID: 10429716 [PubMed - indexed for MEDLINE]

 

 
Radiology 1999 Apr;211(1):101-10 Related Articles, Books, LinkOut
Click here to read    http://radiology.rsnajnls.org/cgi/content/full/211/1/101
Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?

Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, Schild HH.

Department of Radiology, University of Bonn, Germany.

PURPOSE: To assess the relevance of the signal intensity time course for the differential diagnosis of enhancing lesions in dynamic magnetic resonance (MR) imaging of the breast. MATERIALS AND METHODS: Two hundred sixty-six breast lesions were examined with a two-dimensional dynamic MR imaging series and subtraction postprocessing. Time-signal intensity curves of the lesions were obtained and classified according to their shapes as type I, which was steady enhancement; type II, plateau of signal intensity; or type III, washout of signal intensity. Enhancement rates and curve types of benign and malignant lesions were compared. RESULTS: There were 101 malignant and 165 benign lesions. The distribution of curve types for breast cancers was type I, 8.9%; type II, 33.6%; and type III, 57.4%. The distribution of curve types for benign lesions was type I, 83.0%; type II, 11.5%; and type III, 5.5%. The distributions proved significantly different (chi 2 = 139.6; P < .001). The diagnostic indices for signal intensity time course were sensitivity, 91%; specificity, 83%; and diagnostic accuracy, 86%. The diagnostic indices for the enhancement rate were sensitivity, 91%; specificity, 37%; and diagnostic accuracy, 58%. CONCLUSION: The shape of the time-signal intensity curve is an important criterion in differentiating benign and malignant enhancing lesions in dynamic breast MR imaging. A type III time course is a strong indicator of malignancy and is independent of other criteria.

Publication Types:
  • Clinical Trial

PMID: 10189459 [PubMed - indexed for MEDLINE]

 

 

J Magn Reson Imaging 1999 Feb;9(2):187-96 Related Articles, Books, LinkOut
Click here to read    http://www3.interscience.wiley.com/cgi-bin/abstract/55001010/START
Do T2-weighted pulse sequences help with the differential diagnosis of enhancing lesions in dynamic breast MRI?

Kuhl CK, Klaschik S, Mielcarek P, Gieseke J, Wardelmann E, Schild HH.

Department of Radiology, University of Bonn, Germany. kuhl@uni-bonn.de

In this study, our purpose was to determine whether T2-weighted images are a useful diagnostic adjunct for lesion characterization in dynamic breast MRI. On a 1.5-T system, 205 enhancing benign and malignant breast tumors were examined. The standardized protocol consisted of a T2-weighted turbo spin echo (TSE) pulse sequence with and without spectral fat suppression (SPIR), followed by a two-dimensional dynamic series with subtraction postprocessing. In 59 cases, T2*-weighted gradient-echo images also were obtained. Two independent radiologists visually rated the lesions (101 malignant, 104 benign) as having either a low or a high signal with respect to the adjacent glandular tissue. To assess age dependency of lesion enhancement velocities and T2-TSE signal intensities, we compared the results for patients at or below the age of 50 (group A), between 40 and 50 (group B), and beyond the age of 50 (group C). In T2-weighted TSE images, breast cancers were iso- or hypointense with respect to breast parenchyma in 87% of cases, whereas fibroadenomas were hyperintense in 71%. Visual assessment of lesion appearance in T2-weighted TSE images allowed to distinguish between fibroadenomas and breast cancers, with a respective sensitivity, specificity, positive predictive value, and negative predictive value of 72%, 75%, 46%, and 90% for young patients; 94%, 66%, 78%, and 89% for the patients between 40 and 50; and 89%, 62%, 85%, and 68% for the patients over 50 years of age. No significant difference was found for the distribution of signal intensities of lesions in T2*-weighted images or in fat-suppressed images. In a contrast-enhancing breast lesion, careful analysis of T2-weighted TSE images can improve differential diagnosis. The accuracy of this criterion varies with age.

PMID: 10077012 [PubMed - indexed for MEDLINE]

 

 
Radiology 1997 Jul;204(1):123-9 Related Articles, Books, LinkOut

Fibroadenomas: MR imaging appearances with radiologic-histopathologic correlation.

Hochman MG, Orel SG, Powell CM, Schnall MD, Reynolds CA, White LN.

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

PURPOSE: To identify histopathologic correlates for the varied magnetic resonance (MR) imaging appearances of fibroadenomas. MATERIALS AND METHODS: Twenty-three fibroadenomas in 21 patients (aged 23-66 years) examined with gadolinium-enhanced MR imaging were graded for signal intensity on T2-weighted images, contrast material enhancement, shape, and internal septations and were correlated with histopathologic findings. RESULTS: Fibroadenomas demonstrated high T2 signal intensity with enhancement (n = 11), low T2 signal intensity with enhancement (n = 3), or low T2 signal intensity without enhancement (n = 9). Low T2 signal intensity and lack of enhancement were associated with more sclerotic stroma and older patient age. Lesion shape was lobular, oval, or round in 19 of 23 fibroadenomas (83%). Internal septations were identified within nine of 14 enhancing fibroadenomas (64%) and appeared to correlate with collagenous bands at histopathologic analysis. CONCLUSION: Fibroadenomas demonstrate marked histopathologic variability. The resultant variability in the MR appearance limits the ability to distinguish between benign and malignant masses on the basis of signal intensity and enhancement alone. Lobulation and internal septation, which appear to reflect intrinsic growth patterns of fibroadenomas, may provide a more reliable basis for distinction.

PMID: 9205233 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 1997 May;168(5):1331-4 Related Articles, Books, LinkOut

The variability of fibroadenoma in contrast-enhanced dynamic MR mammography.

Brinck U, Fischer U, Korabiowska M, Jutrowski M, Schauer A, Grabbe E.

Department of Pathology, Georg-August-University Goettingen, Germany.

PMID: 9129437 [PubMed - indexed for MEDLINE]

 

 
Radiology 1996 Nov;201(2):427-32 Related Articles, Books, LinkOut

Three-dimensional RODEO breast MR imaging of lesions containing ductal carcinoma in situ.

Soderstrom CE, Harms SE, Copit DS, Evans WP, Savino DA, Krakos PA, Farrell RS Jr, Flamig DP.

Department of Radiology, Baylor University Medical Center, Dallas, Tex., USA.

PURPOSE: To assess whether rotating delivery of excitation off resonance (RODEO) breast magnetic resonance (MR) imaging can help detect ductal carinoma in situ (DCIS) lesions, determine tumor extent, and differentiate pure DCIS from DCIS with an invasive component. MATERIALS AND METHODS: Twenty-two patients with DCIS lesions were evaluated with three-dimensional RODEO MR imaging. Nineteen patients had available mammograms for review. RESULTS: MR imaging enabled detection of all 22 cases of DCIS, DCIS with microinvasion, or invasive ductal carcinoma with extensive intraductal component. A clumped enhancement pattern was seen on MR images in all cases of pure DCIS. Spiculated enhancement was seen in four of six (67%) patients who had DCIS with microinvasion and in nine of 11 (82%) who had invasive ductal carcinoma with extensive intraductal component. RODEO MR imaging enabled accurate determination of tumor extent in 21 of 22 (95%) patients. Mammography depicted 18 of 19 DCIS lesions. No mammographic feature helped differentiate pure DCIS from DCIS with microinvasion. Mammography enabled accurate determination of tumor extent in 14 of 19 (74%) patients. CONCLUSION: Three-dimensional RODEO MR imaging can be an adjunct to mammography because of its ability to enable better determination of tumor extent and differentiation of pure DCIS from DCIS with an invasive component.

PMID: 8888235 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 1996 Aug;167(2):539-40 Related Articles, Books, LinkOut

Mucinous carcinoma of the breast: potential false-negative MR imaging interpretation.

Miller RW, Harms S, Alvarez A.

Publication Types:
  • Letter

PMID: 8686654 [PubMed - indexed for MEDLINE]

 

 
Radiology 1995 Sep;196(3):593-610 Related Articles, Books, LinkOut

MR imaging of the breast.

Weinreb JC, Newstead G.

Department of Radiology, New York University Medical Center, NY 10016, USA.

Studies suggest that magnetic resonance (MR) imaging may have a variety of roles in the detection and management of breast disease. However, because study methods and imaging techniques are not standard, there is still a great deal of uncertainty about its place in clinical practice. The authors review the current state of breast MR imaging and address a number of issues, including the basis for contrast material-enhanced imaging, techniques, and possible clinical roles, including treatment planning, evaluation of the posttreatment breast, evaluation of breast implants, characterization of breast masses, MR imaging-guided biopsy, and the potential for cancer screening. Although it is premature to recommend the routine use of breast MR imaging, contrast-enhanced MR imaging has potential as a comprehensive platform for the detection, localization, biopsy, and treatment of breast cancers.

Publication Types:
  • Review
  • Review, Tutorial

PMID: 7644617 [PubMed - indexed for MEDLINE]

 

 
AJR Am J Roentgenol 1986 Jan;146(1):119-25 Related Articles, Books, LinkOut

Magnetic resonance imaging in the diagnosis of breast disease.

Dash N, Lupetin AR, Daffner RH, Deeb ZL, Sefczek RJ, Schapiro RL.

Magnetic resonance imaging (MRI) of the breast was performed in 10 volunteers and 102 women with suspected breast disease, using a 0.35-T superconducting magnet. All patients had prior x-ray mammography. MRI was superior to mammography in differentiating solid from cystic lesions and equivalent to mammography in providing information regarding different parenchymal patterns. Of 21 surgically proven carcinomas of the breast, MRI correctly identified 18 and mammography identified 19. The major disadvantage of MRI is its inability to show calcifications, benign or malignant. Future studies will be needed to show the relative values of sonography and MRI in detecting small cysts. In addition, MRI in future should be able to demonstrate small, noncalcified masses in mammographically dense, fibrocystic breasts.

PMID: 3484399 [PubMed - indexed for MEDLINE]