Pre-operative staging of invasive breast cancer with MR mammography and/or PET: boon or bunk?

This study compared pre-operative staging with MR mammography (MRM) and positron emission tomography (PET) in patients with clinically suspected breast cancer according to the Breast Imaging Reporting and Data System, category 5. A total of 43 patients with breast cancer were examined. MRM included both T(2) weighted turbo spin echo sequences and T(1) weighted gradient echo sequences (three-dimensional fast low angle shot) before and after application of gadolinium-DPTA. All patients then underwent examination with a modern full-ring PET scanner following injection of fluorodeoxyglucose. We evaluated the efficacy of these methods in the diagnosis of primary tumour, contralateral carcinomas, bifocal, trifocal or multifocal disease, as well as non-invasive cancer portions and tumour size. Determination of patients' N-status was only attempted using PET. All findings were validated by histological examination. MRM was slightly superior to PET in several areas, such as in the respective methods' sensitivity and specificity. Sensitivities for MRM and PET were: 100% vs 93.0% in diagnosis of the primary tumour; 100% vs 100% in diagnosis of contralateral carcinomas; and 95.2% vs 92.5% in diagnosis of bifocal, trifocal or multifocal disease. Specificities for MRM and PET were: 100% vs 97.5% in diagnosis of contralateral carcinomas; and 96.8% vs 90.3% in diagnosis of bifocal, trifocal or multifocal disease. Non-invasive cancer portions and tumour sizes were equally well determined with both methods. The sensitivity of PET for detection of lymph node involvement was 80% and specificity 95%. MRM and PET were superior to conventional methods in nearly all areas studied; the findings of one or both of the methods impacted positively on patients' surgical treatment in 12.5-15% of cases. Pre-operative MRM and/or PET can have a positive influence on surgical treatment planning. Therefore, it appears useful to perform pre-operative staging with MRM or PET in these patients.     

Contralateral lesions detected by preoperative MRI in patients with recently diagnosed breast cancer: application of MR CAD in differentiation of benign and malignant lesions

Objectives

To retrospectively investigate the added value of kinetic features measured by computer-aided diagnosis (CAD) for differentiating benign and malignant contralateral breast lesions detected by preoperative MRI in breast cancer patients.

Methods

This study was approved by our institutional review board, and the requirement for informed consent was waived. Fifty-two breast MR images and their CAD kinetic features were obtained for 52 consecutive breast cancer patients with contralateral breast lesions detected by preoperative MRI and confirmed by excision (23 cancers and 29 benign lesions). Three experienced radiologists independently reviewed the MR images without CAD information and assessed probabilities of malignancy. Four weeks later, these probabilities were reanalyzed using stored CAD data. Diagnostic performances and detection rates of delayed washout components were compared between interpretations without and with CAD for each reader.

Results

Use of MR CAD increased detection of washout component by 2.4- to 3.7-fold than visual assessment for enhancing contralateral lesions, which increased sensitivity (91% vs. 87% in reader 1; 96% vs. 74% in reader 2; 91% vs. 70% in reader 3) and decreased specificity, but statistical significance was only found for decreased specificity in one reader (52% vs. 28%, P = 0.039), and overall performance (areas under ROC curves 0.672 vs. 0.616 in reader 1; 0.624 vs. 0.603 in reader 2; 0.706 vs. 0.590 in reader 3) remained unimproved.

Conclusion

Addition of MR CAD increased sensitivity and decreased specificity than radiologist's assessment alone for differentiating benign and malignant contralateral lesions in breast cancer patients and overall performance remained unimproved.     

Is the “blooming sign” a promising additional tool to determine malignancy in MR mammography?

The aim of this study was to evaluate potential diagnostic relevance of blooming effect for verification of suspicious breast lesions in MR mammography (MRM). The MRM examinations of 1035 patients, all following the same imaging protocol (from 1994 to 2001) were retrospectively evaluated by two experienced radiologists in consensus. A total of 817 lesions showed a focal enhancement; of these, 793 were histologically verified after surgical intervention so that 514 malignant and 279 benign lesions could be evaluated. Using a 1.5-T Gyroscan ACS II-imager (Philips, Hamburg, Germany) and a double breast coil with the patient lying in a prone position, 0.1 mmol/kgbw Magnevist (Schering, Berlin, Germany) were injected into the cubital vein to obtain dynamic axial and coronal T1-weighted fast-field-echo images every minute up to 7 min after bolus injection. Blooming sign describes a progradient unsharpness of lesion borders initially sharply shaped and fast enhancing 7 min after bolus injection; 324 of 514 (63.0%) malignant lesions and 41 of 279 (14.7%) benign lesions revealed a blooming sign (sensitivity 63.0%, specificity 85.3%, accuracy 70.9%, positive predictive value 88.8%, negative predictive value 56.0%). Forty-one of 279 benign lesions showed a blooming sign; of these, there were 4 of 86 (4.7%) fibroadenomas, 2 of 21 (9.5%) phylloides tumours, 11 of 38 (28.9%) papillomas, 3 of 9 (33.3%) radial scars, 2 of 19 (10.5%) mastitis, 1 of 4 (25%) galactophoritis, 1 of 3 (33.3%) ADH and 19 of 99 (17.2%) mastopathic proliferations, respectively. Blooming sign is a phenomenon which should be taken into account when diagnosing MR mammographies because it might increase the ability to discriminate uncertain breast lesions; however, this effect can only be used as an additional item to other well-known effects such as plateau, washout and cancer corner.     

Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions

PURPOSE: To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS: The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS: Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION: Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.     

3.0 Tesla vs 1.5 Tesla breast magnetic resonance imaging in newly diagnosed breast cancer patients

AIM:To compare 3.0 Tesla(T) vs 1.5T magnetic resonance(MR) imaging systems in newly diagnosed breast cancer patients.METHODS:Upon Institutional Review Board approval,a Health Insurance Portability and Accountability Actcompliant retrospective review of 147 consecutive 3.0T MR examinations and 98 consecutive 1.5T MR examinations in patients with newly diagnosed breast cancer between 7/2009 and 5/2010 was performed.Eleven patients who underwent neoadjuvant chemotherapy in the 3.0T group were excluded.Mammographically occult suspicious lesions(BIRADS Code 4 and 5) additional to the index cancer in the ipsilateral and contralateral breast were identified.Lesion characteristics and pathologic diagnoses were recorded,and results achieved with both systems compared.Statistical significance was analyzed using Fisher’s exact test.RESULTS:In the 3.0T group,206 suspicious lesions were identified in 55%(75/136) of patients and 96%(198/206) of these lesions were biopsied.In the 1.5T group,98 suspicious lesions were identified in 53%(52/98) of patients and 90%(88/98) of these lesions were biopsied.Biopsy results yielded additional malignancies in 24% of patients in the 3.0T group vs 14% of patients in the 1.5T group(33/136 vs 14/98,P = 0.07).Average size and histology of the additional cancers was comparable.Of patients who had a suspicious MR imaging study,additional cancers were found in 44% of patients in the 3.0T group vs 27% in the 1.5T group(33/75 vs 14/52,P = 0.06),yielding a higher positive predictive value(PPV) for biopsies performed with the 3.0T system.CONCLUSION:3.0T MR imaging detected more additional malignancies in patients with newly diagnosed breast cancer and yielded a higher PPV for biopsies performed with the 3.0T system.     

乳腺疾病的X线钼靶与MRI对比研究

目的 分析乳腺疾病的X线钼靶与MRI影像学表现,评价X线钼靶与MRI对乳腺疾病的诊断价值。方法 回顾性分析了60例乳腺疾病的X线钼靶与MRI表现,MRI分别采用自旋回波T1WI、短时反转恢复(STIR)序列及动态增强扫描。X线钼靶采用常规方法摄片。结果MRI 53例诊断正确,与病理结果相符,MRI诊断的准确率为88.3％,X线钼靶38例诊断正确,与病理结果相符,X线钼靶诊断的准确率为63.3％,两者差异具有显著性意义,X2=10.23,P<0.01。结论 MRI对乳腺疾病的诊断价值明显优于X线钼靶,对乳腺疾病的临床诊断及治疗具有重要意义。     

The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer

Preoperative MRI of the breasts has been proven to be the most sensitive imaging modality in the detection of multifocal or multicentric tumor manifestations as well as simultaneous contralateral breast cancer. The aim of the presented retrospective study was to evaluate the benefit of preoperative MRI for patients with breast cancer. Preoperative MRI performed in 121 patients (group A) were compared to 225 patients without preoperative MRI (group B). Patients of group A underwent contrast-enhanced MR imaging of the breast using a 2D FLASH sequence technique (TR/TE/FA 336 ms/5 ms/90°; 32 slices of 4-mm thickness, time of acquisition 1:27 min, contrast agent dosage 0.1 mmol Gd-DTPA/kg bw). All patients had histologically verified breast cancer and follow-up for more than 20 months (mean time group A: 40.3 months, group B: 41 months). Both groups received the same types of systemic treatment after breast conserving surgery. The in-breast tumor recurrence rate in group A was 1/86 (1.2%) compared to 9/133 (6.8%) in group B. Contralateral carcinoma were detected within follow-up in 2/121 (1.7%) in group A vs. 9/225 (4%) in group B. All results were statistically significant (P<0.001). Based on these results, preoperative MRI of the breasts is recommended in patients with histopathologically verified breast cancer for local staging.This revised version was published online September 2004 with the following changes: two of the co-authors have withdrawn their names and the data on thoracic wall recurrence rate have been deleted.     

CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer

PURPOSE: To evaluate the role of contrast-enhanced Magnetic Resonance Mammography (MRM) in the evaluation of the contralateral breast in patients with recently diagnosed breast cancer. MATERIALS AND METHODS: Fifty patients with proved unilateral breast cancer, with a negative contralateral breast at physical examination, ultrasound and mammography, were studied with a 1.5 T magnet (Siemens, Vision Plus, Germany). A bilateral breast surface coil was used. Dynamic 3D Flash T1-weighted sequences were acquired in the axial plane before and 0, 2, 4, 6 and 8 minutes after the administration of 0.1 mmol/kg of Gd-BOPTA at a flow rate of 2 ml/s followed by 10 ml of saline. The level of suspicion was reported on a scale from 0 to 5 following the BI-RADS classification, based on lesion morphology and kinetic features. The results were compared with the histological findings after biopsy or surgery. RESULTS: Fourteen out of 50 patients (28%) had contralateral lesions identified on MRM. Biopsy was performed in four of them for suspicious lesions (BI-RADS 4) while 10 patients underwent surgery because of highly suggestive malignant lesions (BI-RADS 5). Histology diagnosed three fibroadenomas, 5 ductal carcinomas in situ, 2 lobular carcinomas in situ, 3 invasive ductal carcinomas and 1 invasive lobular carcinoma. Contrast-enhanced MRM yielded no false negative and three false positives. CONCLUSIONS: Our results demonstrate a very good accuracy of Magnetic Resonance Mammography in the detection of synchronous contralateral cancer in patients with newly diagnosed breast cancer. Therefore, contrast-enhanced MRM could be introduced to screen patients with proven breast cancer before they undergo surgery.     

MR Imaging of the breast. Localization of focal breast lesions with the magnetom open at 0.2 T

Summary Purpose: To answer the following questions: whether reliable detection of lesions is possible in low-field-MRI-system (Magnetom Open 0.2 T) equipped with currently available hard- and software components in comparison to high field system (Magnetom Impact 1.0 T). Furthermore, whether localization of lesions suspect in MR-mammography can be realized in MR system of low field (Magnetom Open 0.2 T). Patients and Methods: In 11 patients, suspect lesions were diagnosed in diagnostic MR-mammography acquired with high field system (Magnetom Impact 1.0 T) and were compared to low field MR-mammographies of 0.2 T (Magnetom Open 0.2 T). In six of the 11 patients a suspect lesion was localized using wire marking. Results: All lesions considered suspect in diagnostic MR-mammography (Magnetom Impact 1.0 T) were also clearly identified in the 0.2 T system (Magnetom Open). In six cases wire marking was performed without any complications and with an accuracy of K 0.5 cm distance to the lesion. Conclusion: Although studies in the 0.2 T system clearly showed inferior SNR (34.6 vs. 83.1) and CNR (14.6 vs. 43.5) compared to studies with the high field system, all lesions considered suspect in diagnostic MR-mammography were reliably identified also in 0.2 T studies. Due to its open construction permitting permanent access to the breast and due to sufficient image quality, the Magnetom Open is suitable for interventions on the breast.      

New subtraction algorithms for evaluation of lesions on dynamic contrast-enhanced MR mammography

We report new subtraction algorithms for the detection of lesions in dynamic contrast-enhanced MR mammography(CE MRM). Twenty-five patients with suspicious breast lesions underwent dynamic CE MRM using 3D fast low-angle shot. After the acquisition of the T1-weighted scout images, dynamic images were acquired six times after the bolus injection of contrast media. Serial subtractions, step-by-step subtractions, and reverse subtractions, were performed. Two radiologists attempted to differentiate benign from malignant lesion in consensus. The sensitivity, specificity, and accuracy of the method leading to the differentiation of malignant tumor from benign lesions were 85.7, 100, and 96%, respectively. Subtraction images allowed for better visualization of the enhancement as well as its temporal pattern than visual inspection of dynamic images alone. Our findings suggest that the new subtraction algorithm is adequate for screening malignant breast lesions and can potentially replace the time–intensity profile analysis on user-selected regions of interest. Electronic Publication     

Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations

Objective

To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.

Materials and methods

The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.

Results

Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively).

Conclusions

The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.     

Evaluation of PET and MR datasets in integrated 18F-FDG PET/MRI: A comparison of different MR sequences for whole-body restaging of breast cancer patients

ObjectivesTo investigate the diagnostic value of different MR sequences and 18F-FDG PET data for whole-body restaging of breast cancer patients utilizing PET/MRI.MethodsA total of 36 patients with suspected tumor recurrence of breast cancer based on clinical follow-up or abnormal findings in follow-up examinations (e.g. CT, MRI) were prospectively enrolled in this study. All patients underwent a PET/CT and subsequently an additional PET/MR scan. Two readers were instructed to identify the occurrence of a tumor relapse in subsequent MR and PET/MR readings, utilizing different MR sequence constellations for each session. The diagnostic confidence for the determination of a malignant or benign lesion was qualitatively rated (3-point ordinal scale) for each lesion in the different reading sessions and the lesion conspicuity (4-point ordinal scale) for the three different MR sequences was additionally evaluated.ResultsTumor recurrence was present in 25/36 (69%) patients. All three PET/MRI readings showed a significantly higher accuracy as well as higher confidence levels for the detection of recurrent breast cancer lesions when compared to MRI alone (p < 0.05). Furthermore, all three PET/MR sequence constellations showed comparable diagnostic accuracy for the identification of a breast cancer recurrence (p > 0.05), yet the highest confidence levels were obtained, when all three MR sequences were used for image interpretation. Moreover, contrast-enhanced T1-weighted VIBE imaging showed significantly higher values for the delineation of malignant and benign lesions when compared to T2 w HASTE and diffusion-weighted imaging.ConclusionIntegrated PET/MRI provides superior restaging of breast cancer patients over MRI alone. Facing the need for appropriate and efficient whole-body PET/MR protocols, our results show the feasibility of fast and morphologically adequate PET/MR protocols. However, considering an equivalent accuracy for the detection of breast cancer recurrences in the three PET/MR readings, the application of contrast-agent and the inclusion of DWI in the study protocol seems to be debatable.     

Early response of breast cancer bone metastases to chemotherapy evaluated with MR imaging

Purpose: To compare T1-weighted spin-echo and fat-suppressed long echo time inversion recovery turbo spin-echo (long TE IR-TSE) MR images in the evaluation of early response of breast cancer bone metastases to chemotherapy.Material and Methods: Eighteen breast cancer patients with known bone metastases were investigated prospectively by MR, using T1-weighted and long TE IR-TSE sequences on the sternum, spine, pelvis and proximal femora, before and after a median of 6 courses of chemotherapy. Therapeutic response evaluation with MR was based on change in tumor size assessed quantitatively by measuring all focal metastases, and change in pattern and signal intensity (SI) of the metastases, assessed visually. Combined response evaluation based on clinical findings, conventional radiography, and scintigraphy was used as reference.Results: Progressive disease (2 patients) and no change (4 patients) were assessed equally well on both MR sequences. Long TE IR-TSE demonstrated partial response with higher accuracy than T1-weighted images, 58% (7/12 patients) vs. 17% (2/12 patients). In patients without progression there was an SI increase in or around the metastases in 6 patients on T1-weighted images and in 7 patients on long TE IR-TSE images.Conclusion: The long TE IR-TSE sequence demonstrated early partial response of breast cancer bone metastases to chemotherapy more accurately than the T1-weighted sequence.     

乳腺纤维腺瘤的3.0T MRI表现

目的：探讨乳腺纤维腺瘤3.0T MRI表现,提高对乳腺疾病的诊断准确性。方法：回顾性分析19例（21个病灶）经手术或穿刺病理证实的乳腺纤维腺瘤患者的MRI资料。分析病灶的MRI形态学特征、信号强度及动态增强特征。结果：所有病灶边界清晰,14个病灶可见分叶状改变,T2WI上11个病灶显示不完整的包膜,病灶内可见低信号分隔：T2WI显示4个,TIRM-T2WI显示10个,增强后显示11个。增强扫描示病灶强化均匀17个,不均匀4个。病灶的时间-信号强度曲线分为4种类型：Ⅰ型曲线17个,Ⅱ型曲线2个,Ⅳ型曲线2个。结论：清晰的边界、分叶状形态、不完整的包膜、无强化的内部间隔和持续均匀的强化是纤维腺瘤的MRI特征性表现,3.0T MRI能清晰地显示上述细微结构,对乳腺纤维腺瘤的诊断具有重要意义。     

Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging

The aim of this study was to compare the diagnostic performance of conventional mammography and dynamic contrast-enhanced fast 3D gradient-echo (GRE) MRI regarding the detection and characterization of breast lesions relative to histopathologic analysis and to assess the results of a combined evaluation of both methods. fifty consecutive patients with 63 histopathologically verified breast lesions underwent dynamic contrast-enhanced GRE MRI in addition to routine conventional mammography. All lesions were classified by both methods on a five-point scale as benign or malignant, and the results were correlated to histopathology. Conventional mammography and dynamic MRI yielded a sensitivity and specificity of 82 and 64 %, and 92 and 76 %, respectively. The difference between the results was statistically not significant (p > 0.05) with areas under the receiver-operating-characteristics curves of 0.807 for mammography and 0.906 for MR imaging. Combination of the results of both methods slightly increased the sensitivity for detection of breast cancer to 95 % but decreased specificity to 52 %. In this selected patient subset, including only patients referred for excisional biopsy, contrast-enhanced dynamic MRI proved more sensitive and specific than conventional mammography regarding the detection of malignancy. While a combination of both methods yields a slightly improved sensitivity, specificity is vastly reduced. Received 5 May 1997; Revision received 14 July 1997; Accepted 7 August 1997     

Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer

Purpose

This study was done to verify the usefulness of preoperative breast magnetic resonance (MR) imaging in patients with newly diagnosed breast cancer.

Materials and methods

A retrospective analysis of 291 patients with invasive breast cancer newly diagnosed with conventional breast imaging (mammography and ultrasound) was performed. All patients underwent MR imaging prior to surgery. The MR imaging detection rate of additional malignant cancers occult to mammography and ultrasound was calculated. Data were analysed with Fisher??s exact test (p<0.05) according to the following parameters: histopathological features of the index tumour (histological type and size) and mammographic density [according to the Breast Imaging Reporting and Data System (BI-RADS) classification from 1 fatty to 4 dense). The gold standard was the histological examination on the surgical specimen.

Results

MR imaging identified 40 mammographically and sonographically occult malignant lesions other than the index cancer in 27/291 patients (9%). These additional cancers were located in the same quadrant as the index cancer in 13 women (4%), in a different quadrant in 12 (4%) and in the contralateral breast in the remaining two (1%). The cancer detection rate in the subgroup of index cancers with lobular histological type was 25%, significantly higher (p=0.03) than the detection rate of 11% recorded in the subgroup of ductal cancers. The cancer detection rate in the subgroup of index cancers >2 cm was 27%, significantly higher (p=0.001) than the rate of 8% found in the subgroup of index cancers <2 cm. Mammographic density was not correlated (p=0.48) with MR detection of additional cancer, with 14% of additional malignancies being detected in both dense and fatty breasts.

Conclusions

In patients with newly diagnosed invasive breast cancer, preoperative MR imaging is useful for detecting additional synchronous malignancies that are not detected on conventional breast imaging. The cancer detection rate is 9%. The use of preoperative MR imaging as an adjunct to conventional breast imaging in women with an infiltrating lobular index cancer and an index cancer >2 cm is especially beneficial.     

MR lesion detection in a breast cancer population

Implementation of MR imaging of the breast as an extension of the existing imaging modalities in the diagnosis of breast cancer was evaluated in a university cancer center. MR imaging of the breast was performed in 54 patients, in whom the MR results were compared with the triple test (the combination of clinical examination, mammographic evaluation, and cytology) and the final histological diagnosis. MR imaging of the breast depicted 30 of the 33 malignancies (sensitivity, 91%). In two of the malignancies, the carcinoma was clinically and mammographically occult. For the three patients with a false-negative MRI diagnosis, the conventional mammography showed suspicious clustered microcalcifications as a sign of in situ carcinoma. For seven patients, MR imaging of the breast incorrectly suggested the presence of a malignant lesion (specificity, 67%). To improve MR specificity, we perform MR-guided ultrasonographic fine-needle aspiration biopsy (FNAB). Although MR imaging of the breast is a highly sensitive examination, conventional x-ray mammography remains the most efficient imaging modality in the diagnosis of breast cancer. In our patient population, MR imaging of the breast had additional value for women with mammographically dense breast tissue and especially for patients with clinical evidence of breast carcinoma that could not be detected with conventional diagnostic methods.     

Common occurrence of benign liver lesions in patients with newly diagnosed breast cancer investigated by MRI for suspected liver metastases.

The purpose of this study was to determine the prevalence of benign liver lesions in patients with breast cancer who are referred to magnetic resonance (MR) imaging for suspected breast cancer metastases at initial presentation. The original MR imaging reports of consecutive patients with breast cancer were reviewed; these patients had undergone MR imaging at our institution to investigate for suspected breast cancer liver metastases, at initial presentation between April 1993 and May 1998. Determination of the presence of benign and malignant liver lesions in each patient was made, as well as their relative frequencies. Diagnostic accuracy of MR imaging was evaluated by correlation with histologic specimens (5 patients) and imaging follow-up (27 patients). Thirty-four patients with newly diagnosed breast carcinoma were evaluated with MR imaging. A total of 11 (32%) of these patients had benign lesions only. Of 21 (62%) total patients who had malignant liver lesions, 19 had breast cancer metastases (2 had coexistent benign lesions), 1 had metastatic carcinoid, and 1 had hepatocellular carcinoma. No liver lesions were detected in two patients (6%). In one patient with biopsy-proven subcentimeter breast metastases, no focal lesions were shown on MR imaging. No other diagnostic errors in classification of liver lesions by MR imaging occurred, as shown by clinical correlation and imaging follow-up in all patients. True positive detection of malignant liver lesion was 20/21, true negative was 13/13, false positive was 0/13, and false negative was 1/21, for a sensitivity of 95% and a specificity of 100% for the detection of malignant liver lesions. Benign liver lesions are common in breast cancer patients suspected clinically of having liver metastases. Benign lesions alone were observed in one-third of our patients. The high diagnostic accuracy of MR imaging in the evaluation of hepatic lesions underscores the value of this technique for baseline investigation of breast cancer patients with clinically suspected liver metastases, particularly patients in whom treatment approaches are dramatically affected by the presence of liver metastases. J. Magn. Reson. Imaging 1999;10:165-169.     

Value of magnetic resonance imaging in patients with a recent myocardial infarction: Comparison with planar thallium-201 scintigraphy

The diagnostic accuracy of spin-echo Magnetic Resonance (MR) imaging in the detection and localization of a recent myocardial infarction (mean 4 days old) was compared to planar thallium-201 scintigraphy in 20 patients with a documented myocardial infarction. A control group of 10 subjects underwent a similar MR imaging procedure without thallium-201 scintigraphy. T1-weighted MR images (TE 30 msec) showed abnormal thinning of the infarcted left ventricular wall during systole (<50% of the opposite wall) in 11 patients (55%). On T2-weighted multi-echo MR images, (TE 30–60–90–120 msec) abnormally increased signal intensity was found in 17 patients and coincided with the location of the infarction. Thallium-201 scintigraphy detected the infarction in 18 patients. Comparison of T2-MR imaging and thallium-201 scintigraphy showed concordant findings in 82% of the left ventricular segments. In 9% of segements, thallium uptake was reduced with normal T2-MR and in 9% we found a normal thallium uptake with abnormal T2-MR findings. In all subjects of the control group, T1-MR images were normal, and only one subject showed increased signal intensity on T2-MR images. We conclude that the diagnostic accuracy of MR imaging in detecting a myocardial infarction is similar to that of T1-201 scintigraphy.