The Impact of Bilateral Salpingo-Oophorectomy on Breast MRI Background Parenchymal Enhancement and Fibroglandular Tissue

Objective

The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI.

Methods

Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT.

Results

Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P?=?0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT.

Conclusions

BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT.

Key Points

? Background parenchymal enhancement significantly decreases at breast MRI following oophorectomy. ? Fibroglandular tissue significantly decreases on breast MRI following oophorectomy. ? Decrease in background parenchymal enhancement is greater than in fibroglandular tissue. ? Decrease in background parenchymal enhancement occurs earlier than in fibroglandular tissue.     

Inter- and intra-observer agreement of BI-RADS-based subjective visual estimation of amount of fibroglandular breast tissue with magnetic resonance imaging: comparison to automated quantitative assessment

Purpose

To evaluate the inter-/intra-observer agreement of BI-RADS-based subjective visual estimation of the amount of fibroglandular tissue (FGT) with magnetic resonance imaging (MRI), and to investigate whether FGT assessment benefits from an automated, observer-independent, quantitative MRI measurement by comparing both approaches.

Materials and methods

Eighty women with no imaging abnormalities (BI-RADS 1 and 2) were included in this institutional review board (IRB)-approved prospective study. All women underwent un-enhanced breast MRI. Four radiologists independently assessed FGT with MRI by subjective visual estimation according to BI-RADS. Automated observer-independent quantitative measurement of FGT with MRI was performed using a previously described measurement system. Inter-/intra-observer agreements of qualitative and quantitative FGT measurements were assessed using Cohen’s kappa (k).

Results

Inexperienced readers achieved moderate inter-/intra-observer agreement and experienced readers a substantial inter- and perfect intra-observer agreement for subjective visual estimation of FGT. Practice and experience reduced observer-dependency. Automated observer-independent quantitative measurement of FGT was successfully performed and revealed only fair to moderate agreement (k?=?0.209–0.497) with subjective visual estimations of FGT.

Conclusion

Subjective visual estimation of FGT with MRI shows moderate intra-/inter-observer agreement, which can be improved by practice and experience. Automated observer-independent quantitative measurements of FGT are necessary to allow a standardized risk evaluation.

Key Points

? Subjective FGT estimation with MRI shows moderate intra-/inter-observer agreement in inexperienced readers.? Inter-observer agreement can be improved by practice and experience. ? Automated observer-independent quantitative measurements can provide reliable and standardized assessment of FGT with MRI.

     

Breast MRI at 7 Tesla with a bilateral coil and T1-weighted acquisition with robust fat suppression: image evaluation and comparison with 3 Tesla

Objectives

To evaluate the image quality of T1-weighted fat-suppressed breast MRI at 7 T and to compare 7-T and 3-T images.

Methods

Seventeen subjects were imaged using a 7-T bilateral transmit-receive coil and 3D gradient echo sequence with adiabatic inversion-based fat suppression (FS). Images were graded on a five-point scale and quantitatively assessed through signal-to-noise ratio (SNR), fibroglandular/fat contrast and signal uniformity measurements.

Results

Image scores at 7 and 3 T were similar on standard-resolution images (1.1?×?1.1?×?1.1-1.6 mm³), indicating that high-quality breast imaging with clinical parameters can be performed at 7 T. The 7-T SNR advantage was underscored on 0.6-mm isotropic images, where image quality was significantly greater than at 3 T (4.2 versus 3.1, P?≤?0.0001). Fibroglandular/fat contrast was more than two times higher at 7 T than at 3 T, owing to effective adiabatic inversion-based FS and the inherent 7-T signal advantage. Signal uniformity was comparable at 7 and 3 T (P?<?0.05). Similar 7-T image quality was observed in all subjects, indicating robustness against anatomical variation.

Conclusion

The 7-T bilateral transmit-receive coil and adiabatic inversion-based FS technique produce image quality that is as good as or better than at 3 T.

Key Points

? High image quality bilateral breast MRI is achievable with clinical parameters at 7 T. ? 7-T high-resolution imaging improves delineation of subtle soft tissue structures. ? Adiabatic-based fat suppression provides excellent fibroglandular/fat contrast at 7 T. ? 7- and 3-T 3D T1-weighted gradient-echo images have similar signal uniformity. ? The 7-T dual solenoid coil enables bilateral imaging without compromising uniformity.     

Imaging features of sporadic breast cancer in women under 40 years old: 97 cases

Objectives

To evaluate characteristic features of mammography, ultrasound and magnetic resonance imaging (MRI) of sporadic breast cancer in women <40 years and to determine correlations with pathological and biological factors.

Methods

A retrospective review of radiological, clinicopathological and biological features of sporadic breast cancers for women under 40 years at our institution between 2007-2012 covering 91 patients. Mammography was available for 97 lesions, ultrasound for 94 and MRI for 38.

Results

The most common imaging features were masses, nearly all classified BI-RADS 4 or 5. On mammography microcalcifications alone accounted for 31 %, all suspicious. There were 42.6 % luminal B, 24.5 % luminal A, 19.1 % HER2-enriched and 10.6 % triple-negative (TN) tumours by immunohistochemistry. HER2 overexpression was correlated with the presence of calcifications at mammography (P?=?0.03). TN cancers more often had an oval shape and abrupt interface at ultrasound and rim enhancement on MRI. MRI features were suspicious for all cancers and rim enhancement of a mass was a significant predictor of triple-negative tumours (P?=?0.01).

Conclusions

The imaging characteristics of cancers in patients under 40 years without proven gene mutations do not differ from their older counterparts, but appear correlated to phenotypic profiles, which have a different distribution in young women compared to the general population.

Key Points

? Young women have more luminal B/HER2+ phenotypes than older women. ? The appearance of cancers is correlated with their biological profiles. ? Sporadic breast cancer imaging in young women is generally classified BI-RADS 4/5. ? Triple-negative cancers can be misinterpreted as benign, requiring thorough imaging analysis.     

Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

Objectives

To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC).

Methods

One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1?=?minimal, 2?=?mild, 3?=?moderate, 4?=?marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared.

Results

The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen’s kappa showed substantial agreement (k?=?0.73–0.77) before and moderate agreement (k?=?0.43–0.60) after NAC and moderate agreement (k?=?0.62–0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r?=??0.24, p?=?0.03).

Conclusions

BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response.

Key Points

? BPE decreases by an average of 0.87 categories under neoadjuvant chemotherapy. ? The reduction of BPE following neoadjuvant chemotherapy correlates with the tumour response. ? The classification of the BPE shows good agreement among trained readers.

     

The role of breast tomosynthesis in a predominantly dense breast population at a tertiary breast centre: breast density assessment and diagnostic performance in comparison with MRI

Objectives

To compare breast density measured on digital breast tomosynthesis (DBT) (BI-RADS-based breast composition and fully-automatic estimation) and magnetic resonance imaging (MRI) (BI-RADS amount of fibroglandular tissue), and to evaluate the diagnostic performance in terms of sensitivity and specificity of DBT and MRI in a predominantly dense breast population.

Methods

Between 2015 and 2016, 152 women with 103 breast malignancies, who underwent 3-T breast MRI and DBT within 2 months’ time, were enrolled in this study. Breast composition/fibroglandular tissue and findings on DBT (two readers) and MRI were reported using BI-RADS 5th edition. Digital mammography images were analysed for breast percent density (PD) using the Libra software tool.

Results

A majority of women had dense breasts as categorised by breast composition c (heterogeneously dense) (68%) and d (extremely dense) (15%). The mean PD was 44% (range, 18-89%) and the correlation between breast composition and PD was r = 0.6. The diagnostic performance of MRI was significantly higher compared to DBT for one reader as described by the area under the receiver operating characteristic (ROC) curve (p = 0.004) and of borderline significance for the other reader (p = 0.052).

Conclusions

MRI had higher diagnostic performance than DBT in a dense breast population in the tertiary setting.

Key Points

? MRI had higher diagnostic performance than DBT in a dense breast population ? Diagnostic performance of DBT was comparable to MRI in women with fatty breasts ? MRI was superior to DBT in preoperative breast cancer size assessment

     

Contrast enhancement kinetics of normal breast parenchyma in dynamic MR mammography: effects of menopausal status, oral contraceptives, and postmenopausal hormone therapy

Objectives

To investigate effects of menopausal status, oral contraceptives (OC), and postmenopausal hormone therapy (HT) on normal breast parenchymal contrast enhancement (CE) and non-mass-like enhancing areas in magnetic resonance mammography (MRM).

Methods

A total of 459 female volunteers (mean age 49.1?±?12.5?years) underwent T1-weighted 3D MRM 1–5?min after bolus injection of gadobutrol. Quantitative analysis was performed in normal breast parenchyma by manually tracing regions of interest and calculating percentage CE. Semiquantitative analysis was performed in non-mass-like enhancing areas, and signal intensity changes were characterised by five predefined kinetic curve types. The influence of OC (n?=?69) and HT (n?=?24) on CE was studied using random effects models.

Results

Breast parenchymal enhancement was significantly higher in premenopausal than in postmenopausal women (P?<?0.001). CE decreased significantly with the use of OC (P?=?0.01), while HT had negligible effects (P?=?0.52). Prevalence of kinetic curve types of non-mass-like enhancement differed strongly between pre- and postmenopausal women (P?<?0.0001), but was similar in OC users and non-OC users (P?=?0.61) as well as HT users and non-HT users (P?=?0.77).

Conclusions

Normal breast parenchymal enhancement and non-mass-like enhancing areas were strongly affected by menopausal status, while they were not affected by HT use and only moderately by OC use.

Key Points

? Breast parenchymal enhancement at MR mammography is stronger in premenopausal than postmenopausal women. ? The prevalence of strong enhancing non-mass-like areas is greater before menopause. ? Such enhancing non-mass-like areas may impair lesion detection in premenopausal women. ? Breast parenchymal enhancement is only marginally affected by hormone use. ? Discontinuation of hormone use before MR mammography may be unnecessary.     

Diffusion weighted imaging of the normal breast: reproducibility of apparent diffusion coefficient measurements and variation with menstrual cycle and menopausal status

Objectives

To establish the reproducibility of apparent diffusion coefficient (ADC) measurements in normal fibroglandular breast tissue and to assess variation in ADC values with phase of the menstrual cycle and menopausal status.

Methods

Thirty-one volunteers (13 premenopausal, 18 postmenopausal) underwent magnetic resonance twice (interval 11–22?days) using diffusion-weighted MRI. ADC_total and a perfusion-insensitive ADC_high (omitting b?=?0) were calculated. Reproducibility and inter-observer variability of mean ADC values were assessed. The difference in mean ADC values between the two phases of the menstrual cycle and the postmenopausal breast were evaluated.

Results

ADC_total and ADC_high showed good reproducibility (r%?=?17.6, 22.4). ADC_high showed very good inter-observer agreement (kappa?=?0.83). The intraclass correlation coefficients (ICC) were 0.93 and 0.91. Mean ADC values were significantly lower in the postmenopausal breast (ADC_total 1.46?±?0.3?×?10^-3?mm²/s, ADC_high 1.33?±?0.3?×?10^-3?mm²/s) compared with the premenopausal breast (ADC_total 1.84?±?0.26?×?10^-3?mm²/s, ADC_high 1.77?±?0.26?×?10^-3?mm²/s; both P?total P?=?0.2, ADC_high P?=?0.24) or between postmenopausal women taking or not taking oestrogen supplements (ADC_total P?=?0.6, ADC_high P?=?0.46).

Conclusions

ADC values in fibroglandular breast tissue are reproducible. Lower ADC values within the postmenopausal breast may reduce diffusion-weighted contrast and have implications for accurately detecting tumours.

Key Points

? ADC values from fibroglandular breast tissue are measured reproducibly by multiple observers. ? Mean ADC values were significantly lower in postmenopausal than premenopausal breast tissue. ? Mean ADC values did not vary significantly with menstrual cycle. ? Low postmenopausal ADC values may hinder tumour detection on DW-MRI.     

Effect of Aromatase Inhibitors on Background Parenchymal Enhancement and Amount of Fibroglandular Tissue at Breast MR Imaging

Purpose: To evaluate whether treatment with an aromatase inhibitor (AI) influences background parenchymal enhancement (BPE) or amount of fibroglandular tissue (FGT) at breast magnetic resonance (MR) imaging in postmenopausal women with prior history of breast cancer. Materials and Methods: A waiver of authorization and patient consent was granted by the institutional review board for this HIPAA-compliant retrospective study. Postmenopausal women with breast cancer and MR imaging findings of the contralateral unaffected breast, before and during 6-12 months of AI treatment (anastrozole, letrozole, or exemestane), between August 1999 and June 2010 were retrospectively identified (n = 149). Two readers performed blinded side-by-side comparison of BPE and MR imaging-depicted FGT before and during treatment. BPE and FGT were classified as the same or greater on one of the two MR studies and by using categorical scales: minimal, mild, moderate, or marked for BPE and fatty, scattered, heterogeneously dense, or dense for FGT. Consensus was reached in cases of disagreement. The sign test was used to conduct a side-by-side comparison of BPE and FGT before and during AI treatment. Results: A decrease in BPE occurred in 33.9% (37 of 109) of women during anastrozole treatment, while an increase occurred in only one (P < .0001); 28 of 37 decreases resulted in a category change of BPE. A decrease in MR imaging-depicted FGT occurred in 5.5% (six of 109) of women, while no increases occurred (P = .031). During letrozole treatment, a decrease in BPE occurred in 46% (15 of 33), while an increase occurred in one woman (P = .0003); a decrease in FGT occurred in only one woman, and no increases occurred. Similar results were seen when women also undergoing chemotherapy were excluded. Only seven women were treated with exemestane. Conclusion: Treatment with 6-12 months of anastrozole or letrozole was associated with decreases in BPE, which occurred in a greater proportion of women than decreases in FGT. ? RSNA, 2012.     

Correlation between breast density in mammography and background enhancement in MR mammography

Purpose

We aimed to analyse the influence of mammographic breast density on background enhancement (BE) at magnetic resonance (MR) mammography in preand postmenopausal women. In addition, we questioned predictability of contrast-enhancement dynamics of normal fibroglandular tissue (NFT) at MR mammography according to mammographic breast density.

Materials and methods

Twenty-six patients (mean age 51.54±11.5 years; range 37–79 years) who underwent both MR mammography and conventional mammography were included in this retrospective study. Fourteen patients were premenopausal and 12 were postmenopausal. The ethics committee of our institution approved the study. The mammograms were retrospectively reviewed for overall breast density according to the four-point scale (I–IV) of the Breast Imaging Reporting and Data System (BI-RADS) classification. Two radiologists, who were unaware of the clinical data, separately assessed the MR mammography images. Images were assessed for enhancement kinetic features (enhancement kinetic curve and the early-phase enhancement rate) and BE. MR mammography and conventional mammography findings were compared according to BI-RADS breast density category and menopausal status.

Results

Percentage of increased signal intensity values during the first minute did not change according to mammographic breast density, and the mean early-phase enhancement rate scores were similar among breast density groups (p=0.942). There was no significant difference between pre- and postmenopausal groups. Enhancement kinetic features of the different groups based on BI-RADS breast density category and menopausal status were similar. There was no correlation between breast density and BE in either premenopausal (p=0.211) or in postmenopausal (p=0.735) groups.

Conclusions

We determined no correlation between mammographic breast density and so-called BE in MR mammography in either premenopausal or postmenopausal women. NFT at MR mammography cannot be predicted on the basis of mammographic breast density.     

The MRI features of histologically proven ovarian cystadenofibromas��an assessment of the morphological and enhancement patterns

Objectives

To assess the morphological and enhancement features of histologically proven cystadenofibromas (CAFs) on magnetic resonance imaging (MRI).

Methods

Forty-seven histologically proven CAFs (42 benign, five borderline) were retrospectively reviewed. One benign CAF had a synchronous adenocarcinoma in the same ovary. The morphological, signal and enhancement characteristics on MRI were recorded.

Results

The mean long axis diameter of the CAFs was 80?mm. The contralateral ovary was abnormal in 45?% of cases. A solid component was seen in 85?%, which returned low T2-weighted signal in 75?% of CAFs. Septa were seen in 74?% and one CAF was purely cystic. The majority of solid components and septa demonstrated enhancement that was less than the myometrium. Wash-in rates (WIR) of the solid tissue were available for measurement in nine patients with an average WIR of 3.2?l/s.

Conclusion

This is the largest series describing MRI appearances of histologically proven CAFs. They are typically complex adnexal lesions containing septa, cystic components and solid tissue. The majority of solid components demonstrate low T2 signal and minimal enhancement. Almost half of the cases have an abnormal contralateral ovary.

Key Points

? Cystadenofibromas are complex adnexal lesions containing septa, cystic, and solid components. ? Some MRI features of cystadenofibromas overlap with those of malignant ovarian lesions. ? Almost 50?% of patients with a cystadenofibroma have an abnormal contralateral ovary. ? Most contralateral lesions are benign, but we found four borderline tumours.     

Intra-individual randomised comparison of gadobutrol 1.0?M versus gadobenate dimeglumine 0.5?M in patients scheduled for preoperative breast MRI

Objective

To demonstrate non-inferiority of gadobutrol versus gadobenate dimeglumine by intra-individually comparing 0.1?mmol/kg body weight doses for contrast-enhanced breast magnetic resonance imaging (MRI) and prospectively evaluating lesion detection and characterisation in a multicentre trial.

Methods

Two identical breast MRI examinations were performed in 72 patients with biopsy-proven breast cancer, separated by 1?C7?days. Gadobutrol 1.0?M or gadobenate 0.5?M were administered in a randomised order. Lesion detection and characterisation were performed by two independent blinded readers. Lesion tracking, which compared on-site readings and histology from surgery or biopsy, was performed by a third reader. Differences in lesion detection and characterisation were compared between the two contrast agents.

Results

Among 103 lesions, 96 were malignant and 7 were benign. No difference in lesion detection was identified between the contrast agents (82.33?% for gadobutrol, 81.60?% for gadobenate). Assessment of sensitivity in lesion characterisation and Breast Imaging Reporting and Data Systems showed no difference between gadobutrol (92.63?%) and gadobenate (90.53?%). Regarding morphology, there was more non-focal enhancement for gadobutrol than for gadobenate (P?=?0.0057).

Conclusion

Non-inferiority of gadobutrol compared with gadobenate was demonstrated for breast lesion detection and sensitivity in lesion characterisation in breast MRI.

Key Points

? Contrast-enhanced magnetic resonance imaging is now widely used for breast problems. ? Lesion detection in breast MRI differs according to the contrast agent. ? Thus we compared gadobutrol 1?M with gadobenate dimeglumine 0.5?M. ? Gadobutrol was non-inferior to gadobenate dimeglumine for detecting and characterising malignant lesions.     

Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size

Objectives

To compare mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in the detection and size estimation of histologically proven breast cancers using postoperative histology as the gold standard.

Methods

After ethical approval, 80 women with newly diagnosed breast cancer underwent MG, CESM, and MRI examinations. CESM was reviewed by an independent experienced radiologist, and the maximum dimension of suspicious lesions was measured. For MG and MRI, routine clinical reports of breast specialists, with judgment based on the BI-RADS lexicon, were used. Results of each imaging technique were correlated to define the index cancer. Fifty-nine cases could be compared to postoperative histology for size estimation.

Results

Breast cancer was visible in 66/80 MG, 80/80 CESM, and 77/79 MRI examinations. Average lesion largest dimension was 27.31 mm (SD 22.18) in MG, 31.62 mm (SD 24.41) in CESM, and 27.72 mm (SD 21.51) in MRI versus 32.51 mm (SD 29.03) in postoperative histology. No significant difference was found between lesion size measurement on MRI and CESM compared with histopathology.

Conclusion

Our initial results show a better sensitivity of CESM and MRI in breast cancer detection than MG and a good correlation with postoperative histology in size assessment.

Key points

? Contrast-enhanced spectral mammography (CESM) is slowly being introduced into clinical practice. ? Access to breast MRI is limited by availability and lack of reimbursement. ? Initial results show a better sensitivity of CESM and MRI than conventional mammography. ? CESM showed a good correlation with postoperative histology in size assessment. ? Contrast-enhanced spectral mammography offers promise, seemingly providing information comparable to MRI.     

Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: a systematic review

Objectives

To determine the diagnostic accuracy of surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer.

Methods

A systematic review of surveillance mammography compared with ultrasound, magnetic resonance imaging (MRI), specialist-led clinical examination or unstructured primary care follow-up, using histopathological assessment for test positives and follow-up for test negatives as the reference standard.

Results

Nine studies met our inclusion criteria. Variations in study comparisons precluded meta-analysis. For routine ipsilateral breast tumour detection, surveillance mammography sensitivity ranged from 64?C67% and specificity ranged from 85?C97%. For MRI, sensitivity ranged from 86?C100% and specificity was 93%. For non-routine ipsilateral breast tumour detection, sensitivity and specificity for surveillance mammography ranged from 50?C83% and 57?C75% and for MRI 93?C100% and 88?C96%. For routine metachronous contralateral breast cancer detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI.

Conclusion

Although mammography is associated with high sensitivity and specificity, MRI is the most accurate test for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer. Results should be interpreted with caution because of the limited evidence base. Key Points ? Surveillance mammography is associated with high sensitivity and specificity ? Findings suggest that MRI is the most accurate test for detecting further breast cancer ? Robust conclusions cannot be made due to the limited evidence base ? Further research comparing surveillance mammography and other diagnostic tests is required     

A comparative study of breast-specific gamma imaging with the conventional imaging modality in breast cancer patients with dense breasts

Objective

The aim of this study was to evaluate the value of breast-specific gamma imaging (BSGI) as compared with mammography (MMG) and ultrasonography (US).

Methods

This study retrospectively enrolled 121 women with breast cancer (45.0?±?8.1?years) and dense breasts (breast density >50?%). All patients underwent preoperative BSGI, MMG, and US, and the results were correlated with the biopsy results.

Results

In the 121 patients, 153 breast lesions were malignant tumors and 75 lesions were diagnosed as benign tumors. The sensitivity and specificity of BSGI were 92.2 and 89.3?%, while the values of MMG and US were 53.6 and 94.7 and 91.5 and 53.3?%, respectively (p?<?0.0001 and p?<?0.0004). In breast lesions ??1?cm, the sensitivity and specificity of BSGI were 80.6 and 91.5?%, which were different from MMG and US, respectively (p?<?0.0001 and p?<?0.0003). Of 28 patients with 59 multiplicities, BSGI and US found 49 lesions and 51 lesions correctly. However, MMG detected only 26 lesions as malignancies.

Conclusion

Given the results of this study, women with dense breasts are not evaluated with MMG at all and went straight to US or MRI in order to minimize radiation exposure. Due to the high false-positive rate of these modalities, BSGI could then be utilized if the US or MRI are positive.     

Combination of chemical suppression techniques for dual suppression of fat and silicone at diffusion-weighted MR imaging in women with breast implants

Objectives

Silicone breast prostheses prove technically challenging when performing diffusion-weighted MR imaging in the breasts. We describe a combined fat and chemical suppression scheme to achieve dual suppression of fat and silicone, thereby improving the quality of diffusion-weighted images in women with breast implants.

Methods

MR imaging was performed at 3.0 and 1.5?T in women with silicone breast implants using short-tau inversion recovery (STIR) fat-suppressed echo-planar (EPI) diffusion-weighted MR imaging (DWI) on its own and combined with the slice-select gradient-reversal (SSGR) technique. Imaging was performed using dedicated breast imaging coils.

Results

Complete suppression of the fat and silicone signal was possible at 3.0?T using EPI DWI with STIR and SSGR, evaluated with dedicated breast coils. However, a residual silicone signal was still perceptible at 1.5?T using this combined approach. Nevertheless, a further reduction in silicone signal at 1.5?T could be achieved by employing thinner slice partitions and the addition of the chemical-selective fat-suppression (CHESS) technique.

Conclusions

DWI using combined STIR and SSGR chemical suppression techniques is feasible to eliminate or reduce silicone signal from prosthetic breast implants.

Key Points

? Breast magnetic resonance imaging (MRI) is frequently needed following breast implants ? Unsuppressed signal from silicone creates artefacts on diffusion-weighted MR sequences ? Dual fat/chemical suppression can eliminate signal from fat and silicone ? STIR with slice selective gradient reversal can suppress fat and silicone signal     

MRI of the breast in patients with DCIS to exclude the presence of invasive disease

Objectives

Core biopsy underestimates invasion in more than 20% of patients with preoperatively diagnosed ductal carcinoma in situ (DCIS) without evidence of invasion (pure DCIS). The aim of the current study was to evaluate the efficacy of preoperative magnetic resonance imaging (MRI) to discriminate between patients with DCIS who are at high risk of invasive breast cancer and patients at low risk.

Methods

One hundred and twenty-five patients, preoperatively diagnosed with pure DCIS (128 lesions; 3 bilateral) by core-needle biopsy, were prospectively included. Clinical, mammographic, histological (core biopsy) and MRI features were assessed. All patients underwent breast surgery. Analyses were performed to identify features associated with presence of invasion.

Results

Eighteen lesions (14.1%) showed invasion on final histology. Seventy-three lesions (57%) showed suspicious enhancement on MRI with a type 1 (n?=?12, 16.4%), type 2 (n?=?19, 26.0%) or type 3 curve, respectively (n?=?42, 57.5%). At multivariate analysis, the most predictive features for excluding presence of invasive disease were absence of enhancement or a type 1 curve on MRI (negative predictive value 98.5%; A_Z 0.80, P?=?0.00006).

Conclusion

Contrast medium uptake kinetics at MRI provide high negative predictive value to exclude presence of invasion and may be useful in primary surgical planning in patients with a preoperative diagnosis of pure DCIS.

Key Points

? It is important to determine invasion in breast DCIS. ? MRI contrast medium uptake kinetics can help exclude the presence of invasion. ? However, the positive predictive value for the presence of invasion is limited. ? MRI features were more accurate at predicting invasion than mammographic features alone.     

Correlation of contrast agent kinetics between iodinated contrast-enhanced spectral tomosynthesis and gadolinium-enhanced MRI of breast lesions

Objectives

Assessment of contrast agent kinetics in contrast-enhanced MRI (CE-MRI) with gadolinium-containing contrast agents offers the opportunity to predict breast lesion malignancy. The goal of our study was to determine if similar patterns exist for spectral contrast-enhanced digital breast tomosynthesis (CE-DBT) using an iodinated contrast agent.

Methods

The protocol of our prospective study was approved by the relevant institutional review board and the German Federal Office for Radiation Protection. All patients provided written informed consent. We included 21 women with a mean age of 62.4 years. All underwent ultrasound-guided biopsy of a suspect breast lesion, spectral CE-DBT and CE-MRI. For every breast lesion, contrast agent kinetics was assessed by signal intensity–time curves for spectral CE-DBT and CE-MRI. Statistical comparison used Cohen’s kappa and Spearman’s rho test.

Results

Spearman’s rho of 0.49 showed significant (P?=?0.036) correlation regarding the contrast agent kinetics in signal intensity–time curves for spectral CE-DBT and CE-MRI. Cohen’s kappa indicated moderate agreement (kappa?=?0.438).

Conclusion

There is a statistically significant correlation between contrast agent kinetics in the signal intensity–time curves for spectral CE-DBT and CE-MRI. Observing intralesional contrast agent kinetics in spectral CE-DBT may aid evaluation of malignant breast lesions.

Key Points

? Contrast agent kinetics can be assessed using spectral digital breast tomosynthesis (DBT). ? Contrast agent kinetics patterns in spectral DBT are similar to those in contrast-enhanced MRI. ? Multiple contrast enhancement for spectral DBT gives additional diagnostic information.