Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients

International Nuclear Information System (INIS)

Lymberis, Stella C.; Wyngaert, John Keith de; Parhar, Preeti; Chhabra, Arpit M.; Fenton-Kerimian, Maria; Chang Jengwha; Hochman, Tsivia; Guth, Amber; Roses, Daniel; Goldberg, Judith D.; Formenti, Silvia C.

2012-01-01

Purpose: Damage to heart and lung from breast radiotherapy is associated with increased cardiovascular mortality and lung cancer development. We conducted a prospective study to evaluate which position is best to spare lung and heart from radiotherapy exposure. Methods and Materials: One hundred consecutive Stage 0–IIA breast cancer patients consented to participate in a research trial that required two computed tomography simulation scans for planning both supine and prone positions. The optimal position was defined as that which best covered the contoured breast and tumor bed while it minimized critical organ irradiation, as quantified by the in-field heart and lung volume. The trial was designed to plan the first 100 patients in each position to study correlations between in-field volumes of organs at risk and dose. Results: Fifty-three left and 47 right breast cancer patients were consecutively accrued to the trial. In all patients, the prone position was optimal for sparing lung volume compared to the supine setup (mean lung volume reduction was 93.5 cc for right and 103.6 cc for left breast cancer patients). In 46/53 (87%) left breast cancer patients best treated prone, in-field heart volume was reduced by a mean of 12 cc and by 1.8 cc for the other 7/53 (13%) patients best treated supine. As predicted, supine-prone differences in in-field volume and mean dose of heart and lung were highly correlated (Spearman's correlation coefficient for left breast cancer patients was 0.90 for heart and 0.94 for lung and 0.92 for right breast cancer patients for lung). Conclusions: Prone setup reduced the amount of irradiated lung in all patients and reduced the amount of heart volume irradiated in 87% of left breast cancer patients. In-field organ volume is a valid surrogate for predicting dose; the trial continued to the planned target of 400.

Impact of real-time virtual sonography, a coordinated sonography and MRI system that uses an image fusion technique, on the sonographic evaluation of MRI-detected lesions of the breast in second-look sonography.

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Nakano, Shogo; Kousaka, Junko; Fujii, Kimihito; Yorozuya, Kyoko; Yoshida, Miwa; Mouri, Yukako; Akizuki, Miwa; Tetsuka, Rie; Ando, Takahito; Fukutomi, Takashi; Oshima, Yukihiko; Kimura, Junko; Ishiguchi, Tsuneo; Arai, Osamu

2012-08-01

The aim of this study was to verify the utility of second-look sonography using real-time virtual sonography (RVS)-a coordinated sonography with an MRI system that uses an image fusion technique with magnetic navigation-on the sonographic evaluation of MRI-detected lesions of the breast. Of the 196 consecutive patients who were examined with breast MRI in our hospital from 2006 to 2009, those patients who underwent second-look sonography to identify MRI-detected lesions were enrolled in this study. MRI was performed using a 1.5-T imager with the patient in a supine position. To assess the efficacy benefits of RVS, the correlations between lesion detection rates, MRI features, distribution, and histopathological classification on second-look sonography using conventional B-mode or RVS were analyzed. Of the 196 patients, 55 (28 %) demonstrated 67 lesions initially detected by MRI, followed by second-look sonography. Of the 67 MRI-detected lesions, 18 (30 %) were identified with second-look sonography using conventional B-mode alone, whereas 60 (90 %) lesions were detected with second-look sonography using RVS (p use of RVS on second-look sonography significantly increases the sonographic detection rate of MRI-detected lesions without operator dependence.

Multiparametric and molecular imaging of breast tumors with MRI and PET/MRI

International Nuclear Information System (INIS)

Pinker, K.; Marino, M.A.; Meyer-Baese, A.; Helbich, T.H.

2016-01-01

Magnetic resonance imaging (MRI) of the breast is an indispensable tool in breast imaging for many indications. Several functional parameters with MRI and positron emission tomography (PET) have been assessed for imaging of breast tumors and their combined application is defined as multiparametric imaging. Available data suggest that multiparametric imaging using different functional MRI and PET parameters can provide detailed information about the hallmarks of cancer and may provide additional specificity. Multiparametric and molecular imaging of the breast comprises established MRI parameters, such as dynamic contrast-enhanced MRI, diffusion-weighted imaging (DWI), MR proton spectroscopy ( 1 H-MRSI) as well as combinations of radiological and MRI techniques (e.g. PET/CT and PET/MRI) using radiotracers, such as fluorodeoxyglucose (FDG). Multiparametric and molecular imaging of the breast can be performed at different field-strengths (range 1.5-7 T). Emerging parameters comprise novel promising techniques, such as sodium imaging ( 23 Na MRI), phosphorus spectroscopy ( 31 P-MRSI), chemical exchange saturation transfer (CEST) imaging, blood oxygen level-dependent (BOLD) and hyperpolarized MRI as well as various specific radiotracers. Multiparametric and molecular imaging has multiple applications in breast imaging. Multiparametric and molecular imaging of the breast is an evolving field that will enable improved detection, characterization, staging and monitoring for personalized medicine in breast cancer. (orig.) [de

Comparison of Radiation Treatment Plans for Breast Cancer between 3D Conformal in Prone and Supine Positions in Contrast to VMAT and IMRT Supine Positions

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Bejarano Buele, Ana Isabel

The treatment regimen for breast cancer patients typically involves Whole Breast Irradiation (WBI). The coverage and extent of the radiation treatment is dictated by location of tumor mass, breast tissue distribution, involvement of lymph nodes, and other factors. The current standard treatment approach used at our institution is a 3D tangential beam geometry, which involves two fields irradiating the breast, or a four field beam arrangement covering the whole breast and involved nodes, while decreasing the dose to organs as risk (OARs) such as the lung and heart. The coverage of these targets can be difficult to achieve in patients with unfavorable thoracic geometries, especially in those cases in which the planning target volume (PTV) is extended to the chest wall. It is a well-known fact that exposure of the heart to ionizing radiation has been proved to increase the subsequent rate of ischemic heart disease. In these cases, inverse planned treatments have become a proven alternative to the 3D approach. The goal of this research project is to evaluate the factors that affect our current techniques as well as to adapt the development of inverse modulated techniques for our clinic, in which breast cancer patients are one of the largest populations treated. For this purpose, a dosimetric comparison along with the evaluation of immobilization devices was necessary. Radiation treatment plans were designed and dosimetrically compared for 5 patients in both, supine and prone positions. For 8 patients, VMAT and IMRT plans were created and evaluated in the supine position. Skin flash incorporation for inverse modulated plans required measurement of the surface dose as well as an evaluation of breast volume changes during a treatment course. It was found that prone 3D conformal plans as well as the VMAT and IMRT plans are generally superior in sparing OARs to supine plans with comparable PTV coverage. Prone setup leads to larger shifts in breast volume as well as in

The potential of multiparametric MRI of the breast

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Pinker, Katja; Helbich, Thomas H

2017-01-01

MRI is an essential tool in breast imaging, with multiple established indications. Dynamic contrast-enhanced MRI (DCE-MRI) is the backbone of any breast MRI protocol and has an excellent sensitivity and good specificity for breast cancer diagnosis. DCE-MRI provides high-resolution morphological information, as well as some functional information about neoangiogenesis as a tumour-specific feature. To overcome limitations in specificity, several other functional MRI parameters have been investigated and the application of these combined parameters is defined as multiparametric MRI (mpMRI) of the breast. MpMRI of the breast can be performed at different field strengths (1.5–7 T) and includes both established (diffusion-weighted imaging, MR spectroscopic imaging) and novel MRI parameters (sodium imaging, chemical exchange saturation transfer imaging, blood oxygen level-dependent MRI), as well as hybrid imaging with positron emission tomography (PET)/MRI and different radiotracers. Available data suggest that multiparametric imaging using different functional MRI and PET parameters can provide detailed information about the underlying oncogenic processes of cancer development and progression and can provide additional specificity. This article will review the current and emerging functional parameters for mpMRI of the breast for improved diagnostic accuracy in breast cancer. PMID:27805423

Setup accuracy for prone and supine whole breast irradiation

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Mulliez, Thomas; Vercauteren, Tom; Greveling, Annick van; Speleers, Bruno; Neve, Wilfried de; Veldeman, Liv [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); Gulyban, Akos [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); University Hospital Liege, Department of Radiotherapy, Liege (Belgium)

2016-04-15

To evaluate cone-beam computed tomography (CBCT) based setup accuracy and margins for prone and supine whole breast irradiation (WBI). Setup accuracy was evaluated on 3559 CBCT scans of 242 patients treated with WBI and uncertainty margins were calculated using the van Herk formula. Uni- and multivariate analysis on individual margins was performed for age, body mass index (BMI) and cup size. The population-based margin in vertical (VE), lateral (LA) and longitudinal (LO) directions was 10.4/9.4/9.4 mm for the 103 supine and 10.5/22.4/13.7 mm for the 139 prone treated patients, being significantly (p < 0.01) different for the LA and LO directions. Multivariate analysis identified a significant (p < 0.05) correlation between BMI and the LO margin in supine position and the VE/LA margin in prone position. In this series, setup accuracy is significantly worse in prone compared to supine position for the LA and LO directions. However, without proper image-guidance, uncertainty margins of about 1 cm are also necessary for supine WBI. For patients with a higher BMI, larger margins are required. (orig.) [German] Ziel der Arbeit war es, die interfraktionelle Repositionierungsgenauigkeit in Bauchlage (BL) versus Rueckenlage (RL) bei Ganzbrustbestrahlung (GBB) mittels Cone-Beam-CT (CBCT) zu bestimmen, um die notwendigen PTV-Sicherheitsabstaende zu definieren. Die Repositionierungsgenauigkeit wurde basierend an 3559 CBCT-Scans von 242 mit GBB behandelten Patienten ausgewertet. Die PTV-Sicherheitsabstaende wurden unter Verwendung der ''van-Herk''-Formel berechnet. Uni- und multivariable Analysen wurden fuer Sicherheitsabstaende in jede Richtung auf Basis von Alter, Body-Mass-Index (BMI) und Koerbchengroesse durchgefuehrt. Die basierend auf den taeglichen CBCT-Verschiebungen berechneten PTV-Sicherheitsabstaende betrugen in anteroposteriorer (AP), lateraler (LT oder links-rechts) und kraniokaudaler (CC) Richtung 10,4/9,4/9,4 mm fuer die RL (103 Patienten) und

MRI of the Breast

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... in evaluating women at high risk for breast cancer. MRI can successfully image the dense breast tissue common in younger women, and it can successfully image breast implants. Both of these are difficult to image using ...

Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging (MRI): Can breast MRI exclude advanced nodal disease?

International Nuclear Information System (INIS)

Hyun, Su Jeong; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung

2016-01-01

To evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in preoperative evaluation of axillary lymph node metastasis (ALNM) in breast cancer patients and to assess whether breast MRI can be used to exclude advanced nodal disease. A total of 425 patients were included in this study and breast MRI findings were retrospectively reviewed. The diagnostic performance of breast MRI for diagnosis of ALNM was evaluated in all patients, patients with neoadjuvant chemotherapy (NAC), and those without NAC (no-NAC). We evaluated whether negative MRI findings (cN0) can exclude advanced nodal disease (pN2-pN3) using the negative predictive value (NPV) in each group. The sensitivity and NPV of breast MRI in evaluation of ALNM was 51.3 % (60/117) and 83.3 % (284/341), respectively. For cN0 cases on MRI, pN2-pN3 manifested in 1.8 % (6/341) of the overall patients, 0.4 % (1/257) of the no-NAC group, and 6 % (5/84) of the NAC group. The NPV of negative MRI findings for exclusion of pN2-pN3 was higher for the no-NAC group than for the NAC group (99.6 % vs. 94.0 %, p = 0.039). Negative MRI findings (cN0) can exclude the presence of advanced nodal disease with an NPV of 99.6 % in the no-NAC group. (orig.)

Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging (MRI): Can breast MRI exclude advanced nodal disease?

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Hyun, Su Jeong [Yonsei University College of Medicine, Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Seoul (Korea, Republic of); Hallym University Medical Center, Department of Radiology, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung [Yonsei University College of Medicine, Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Seoul (Korea, Republic of)

2016-11-15

To evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in preoperative evaluation of axillary lymph node metastasis (ALNM) in breast cancer patients and to assess whether breast MRI can be used to exclude advanced nodal disease. A total of 425 patients were included in this study and breast MRI findings were retrospectively reviewed. The diagnostic performance of breast MRI for diagnosis of ALNM was evaluated in all patients, patients with neoadjuvant chemotherapy (NAC), and those without NAC (no-NAC). We evaluated whether negative MRI findings (cN0) can exclude advanced nodal disease (pN2-pN3) using the negative predictive value (NPV) in each group. The sensitivity and NPV of breast MRI in evaluation of ALNM was 51.3 % (60/117) and 83.3 % (284/341), respectively. For cN0 cases on MRI, pN2-pN3 manifested in 1.8 % (6/341) of the overall patients, 0.4 % (1/257) of the no-NAC group, and 6 % (5/84) of the NAC group. The NPV of negative MRI findings for exclusion of pN2-pN3 was higher for the no-NAC group than for the NAC group (99.6 % vs. 94.0 %, p = 0.039). Negative MRI findings (cN0) can exclude the presence of advanced nodal disease with an NPV of 99.6 % in the no-NAC group. (orig.)

MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer

International Nuclear Information System (INIS)

Taneja, Sangeeta; Jena, Amarnath; Zaidi, Syed Mohd. Shuaib; Khurana, Anuj

2012-01-01

Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well

Background parenchymal enhancement in preoperative breast MRI.

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Kohara, Satoko; Ishigaki, Satoko; Satake, Hiroko; Kawamura, Akiko; Kawai, Hisashi; Kikumori, Toyone; Naganawa, Shinji

2015-08-01

We aimed to assess the influence of background parenchymal enhancement (BPE) on surgical planning performed using preoperative MRI for breast cancer evaluation. Between January 2009 and December 2010, 91 newly diagnosed breast cancer patients (mean age, 55.5 years; range, 30-88 years) who underwent preoperative bilateral breast MRI followed by planned breast conservation therapy were retrospectively enrolled. MRI was performed to assess the tumor extent in addition to mammography and breast ultrasonography. BPE in the contralateral normal breast MRI at the early dynamic phase was visually classified as follows: minimal (n=49), mild (n=27), moderate (n=7), and marked (n=8). The correlations between the BPE grade and age, menopausal status, index tumor size, changes in surgical management based on MRI results, positive predictive value (PPV) of MRI, and surgical margins were assessed. Patients in the strong BPE groups were significantly younger (p=0.002) and generally premenopausal (p<0.001). Surgical treatment was not changed in 67 cases (73.6%), while extended excision and mastectomy were performed in 12 cases (13.2%), each based on additional lesions on MRI. Six of 79 (7.6%) patients who underwent breast conservation therapy had tumor-positive resection margins. In cases where surgical management was changed, the PPV for MRI-detected foci was high in the minimal (91.7%) and mild groups (66.7%), and 0% in the moderate and marked groups (p=0.002). Strong BPE causes false-positive MRI findings and may lead to overly extensive surgery, whereas MRI may be beneficial in select patients with weak BPE.

Pre-Operative Planning Using Real-Time Virtual Sonography, an MRI/Ultrasound Image Fusion Technique, for Breast-Conserving Surgery in Patients with Non-Mass Enhancement on Breast MRI: A Preliminary Study.

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Ando, Takahito; Ito, Yukie; Ido, Mirai; Osawa, Manami; Kousaka, Junko; Mouri, Yukako; Fujii, Kimihito; Nakano, Shogo; Kimura, Junko; Ishiguchi, Tsuneo; Watanebe, Rie; Imai, Tsuneo; Fukutomi, Takashi

2018-07-01

The purpose of this retrospective study was to evaluate the effect of pre-operative planning using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/ultrasound (US) image fusion technique on breast-conserving surgery (BCS) in patients with non-mass enhancement (NME) on breast MRI. Between 2011 and 2015, we enrolled 12 consecutive patients who had lesions with NME that exceeded the US hypo-echoic area, in which it was particularly difficult to evaluate the tumor margin. During pre-operative planning before breast-conserving surgery, RVS was used to delineate the enhancing area on the breast surface after additional supine breast MRI was performed. We analyzed both the surgical margin positivity rate and the re-operation rate. All NME lesions corresponded to the index cancer. In all patients, the diameter of the NME lesion was greater than that of the hypo-echoic lesion. The median diameters of the NME and hypo-echoic lesions were 24 mm (range: 12-39 mm) and 8.0 mm (range: 4.9-18 mm), respectively (p = 0.0002). After RVS-derived skin marking was performed on the surface of the affected breast, lumpectomy and quadrantectomy were conducted in 7 and 5 patients, respectively. The surgical margins were negative in 10 (83%) patients. Two patients with positive margins were found to have ductal carcinoma in situ in 1 duct each, 2.4 and 3.2 mm from the resection margin, respectively. None of the patients required additional resection. Although further prospective studies are required, the findings of our preliminary study suggest that it is very well possible that the use of RVS-derived skin marking during pre-operative planning for BCS in patients with NME would have resulted in surgical outcomes similar to or better than those obtained without the use of such marking. Copyright © 2018. Published by Elsevier Inc.

Management of breast lesions detectable only on MRI

International Nuclear Information System (INIS)

Siegmann-Luz, K.C.; Bahrs, S.D.; Preibsch, H.; Hattermann, V.; Claussen, C.D.

2014-01-01

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline 'Diagnosis, Therapy, and Follow-Up of Breast Cancer' as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. (orig.)

A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

International Nuclear Information System (INIS)

Kirby, Anna M.; Evans, Philip M.; Helyer, Sarah J.; Donovan, Ellen M.; Convery, Helen M.; Yarnold, John R.

2011-01-01

Purpose: To test a prone position against the international-standard supine position in women undergoing whole-breast-radiotherapy (WBRT) after wide-local-excision (WLE) of early breast cancer (BC) in terms of feasibility, set-up errors, and respiratory motion. Methods: Following WLE of BC with insertion of tumour-bed clips, patients underwent 4D-CT for WBRT-planning in supine and prone positions (the latter using an in-house-designed platform). Patients were randomised to undergo WBRT fractions 1-7 in one position, switching to the alternate position for fractions 8-15 (40 Gy/15-fractions total). Cone-beam CT-images (CBCT) were acquired prior to fractions 1, 4, 7, 8, 11 and 14. CBCT data were matched to planning-CT data using (i) chest-wall and (ii) clips. Systematic and random errors were calculated. Maximal displacement of chest-wall and clips with respiration was measured on 4D-CT. Clinical- to planning-target-volume (CTV-PTV) margins were calculated. Patient-comfort-scores and treatment-times were evaluated. Results: Twenty-five patients were randomized. 192/192 (100%) planned supine fractions and 173/192 (90%) prone fractions were completed. 3D population systematic errors were 1.3-1.9 mm (supine) and 3.1-4.3 mm (prone) (p = 0.02) and random errors 2.6-3.2 mm (supine) and 3.8-5.4 mm (prone) (p = 0.02). Prone positioning reduced chest-wall and clip motion (0.5 ± 0.2 mm (prone) versus 2.7 ± 0.5 mm (supine) (p < 0.001)) with respiration. Calculated CTV-PTV margins were greater for prone (12-16 mm) than for supine treatment (10 mm). Patient-comfort-scores and treatment times were comparable (p = 0.06). Conclusions: Set-up errors were greater using our prone technique than for our standard supine technique, resulting in the need for larger CTV-PTV margins in the prone position. Further work is required to optimize the prone treatment-platform and technique before it can become a standard treatment option at our institution.

Breast MRI, digital mammography and breast tomosynthesis: comparison of three methods for early detection of breast cancer.

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Roganovic, Dragana; Djilas, Dragana; Vujnovic, Sasa; Pavic, Dag; Stojanov, Dragan

2015-11-16

Breast cancer is the most common malignancy in women and early detection is important for its successful treatment. The aim of this study was to investigate the sensitivity and specificity of three methods for early detection of breast cancer: breast magnetic resonance imaging (MRI), digital mammography, and breast tomosynthesis in comparison to histopathology, as well as to investigate the intraindividual variability between these modalities. We included 57 breast lesions, each detected by three diagnostic modalities: digital mammography, breast MRI, and breast tomosynthesis, and subsequently confirmed by histopathology. Breast Imaging-Reporting and Data System (BI-RADS) was used for characterizing the lesions. One experienced radiologist interpreted all three diagnostic modalities. Twenty-nine of the breast lesions were malignant while 28 were benign. The sensitivity for digital mammography, breast MRI, and breast tomosynthesis, was 72.4%, 93.1%, and 100%, respectively; while the specificity was 46.4%, 60.7%, and 75%, respectively. Receiver operating characteristics (ROC) curve analysis showed an overall diagnostic advantage of breast tomosynthesis over both breast MRI and digital mammography. The difference in performance between breast tomosynthesis and digital mammography was significant (p tomosynthesis and breast MRI was not significant (p=0.20).

Breast MRI, digital mammography and breast tomosynthesis: comparison of three methods for early detection of breast cancer

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Dragana Roganovic

2015-11-01

Full Text Available Breast cancer is the most common malignancy in women and early detection is important for its successful treatment. The aim of this study was to investigate the sensitivity and specificity of three methods for early detection of breast cancer: breast magnetic resonance imaging (MRI, digital mammography, and breast tomosynthesis in comparison to histopathology, as well as to investigate the intraindividual variability between these modalities.  We included 57 breast lesions, each detected by three diagnostic modalities: digital mammography, breast MRI, and breast tomosynthesis, and subsequently confirmed by histopathology. Breast Imaging-Reporting and Data System (BI-RADS was used for characterizing the lesions. One experienced radiologist interpreted all three diagnostic modalities. Twenty-nine of the breast lesions were malignant while 28 were benign. The sensitivity for digital mammography, breast MRI, and breast tomosynthesis, was 72.4%, 93.1%, and 100%, respectively; while the specificity was 46.4%, 60.7%, and 75%, respectively. Receiver operating characteristics (ROC curve analysis showed an overall diagnostic advantage of breast tomosynthesis over both breast MRI and digital mammography. The difference in performance between breast tomosynthesis and digital mammography was significant (p < 0.001, while the difference between breast tomosynthesis and breast MRI was not significant (p = 0.20. 

Bilateral symmetry analysis of breast MRI

International Nuclear Information System (INIS)

Alterson, Robert; Plewes, Donald B

2003-01-01

Mammographic interpretation often uses symmetry between left and right breasts to indicate the site of potential tumour masses. This approach has not been applied to breast images obtained from MRI. We present an automatic technique for breast symmetry detection based on feature extraction techniques which does not require any efforts to co-register breast MRI data. The approach applies computer-vision techniques to detect natural biological symmetries in breast MR scans based on three objective measures of similarity: multiresolution non-orthogonal wavelet representation, three-dimensional intensity distributions and co-occurrence matrices. Statistical distributions that are invariant to feature localization are computed for each of the extracted image features. These distributions are later compared against each other to account for perceptual similarity. Studies based on 51 normal MRI scans of randomly selected patients showed that the sensitivity of symmetry detection rate approached 94%. The symmetry analysis procedure presented in this paper can be applied as an aid in detecting breast tissue changes arising from disease

FAST MRI breast screening revisited

International Nuclear Information System (INIS)

Jain, Manish; Jain, Arushi; Hyzy, Marek D.; Werth, Graziella

2017-01-01

Screening for breast cancer in high-risk women takes about 40 minutes to acquire an MRI scan and is time-intensive to report. There is recent interest in the performance of an abbreviated MRI protocol (FAST) in the screening setting. FAST scans have a reported negative predictive value of 99.8%. This study evaluates the false positive rates (FPR) and recall rates for FAST scans as compared to full diagnostic studies (FD). A database of all screening breast MRI scans performed at our institution between 30 June 2013 and 1 July 2014 (n = 591) was created by one of the researchers, who did not subsequently analyse the MRI scans. The T1W and first post-contrast and subtracted images from each of these scans (FAST protocol) were assessed by experienced breast MRI radiologists, blinded to the final diagnosis. The findings were then compared with the FD result. The recall rates were 6.6% for FAST scans and 5.8% for FD scans. FPR rates were 4.7% and 3.9% respectively. There is no statistically significant difference in the recall rates or FPR of FAST scans in comparison with full diagnostic studies. Given the absence of statistically significant difference in the FPR and recall rates in comparison with FD, FAST scans can replace FD for screening of breast cancer.

Breast MRI: EUSOBI recommendations for women's information

International Nuclear Information System (INIS)

Mann, Ritse M.; Balleyguier, Corinne; Baltzer, Pascal A.; Helbich, Thomas H.; Pinker-Domenig, Katja; Bick, Ulrich; Fallenberg, Eva; Colin, Catherine; Cornford, Eleanor; Evans, Andrew; Forrai, Gabor; Fuchsjaeger, Michael H.; Gilbert, Fiona J.; Heywang-Koebrunner, Sylvia H.; Camps-Herrero, Julia; Kuhl, Christiane K.; Martincich, Laura; Pediconi, Federica; Panizza, Pietro; Pina, Luis J.; Pijnappel, Ruud M.; Skaane, Per; Sardanelli, Francesco

2015-01-01

This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADS registered categories and further actions after a breast MRI examination are discussed. Breast MRI is a very sensitive modality, significantly improving screening in high-risk women. It also has a role in clinical diagnosis, problem solving, and staging, impacting on patient management. However, it is not a perfect test, and occasionally breast cancers can be missed. Therefore, clinical and other imaging findings (from mammography/ultrasound) should also be considered. Conversely, MRI may detect lesions not visible on other imaging modalities turning out to be benign (false positives). These risks should be discussed with women before a breast MRI is requested/performed. Because breast MRI drawbacks depend upon the indication for the examination, basic information for the most important breast MRI indications is presented. Seventeen notes and five frequently asked questions formulated for use as direct communication to women are provided. The text was reviewed by Europa Donna-The European Breast Cancer Coalition to ensure that it can be easily understood by women undergoing MRI. (orig.)

Breast MRI: EUSOBI recommendations for women's information

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Mann, Ritse M. [Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen (Netherlands); Balleyguier, Corinne [Gustave-Roussy Institute, Department of Radiology, Villejuif (France); Baltzer, Pascal A.; Helbich, Thomas H.; Pinker-Domenig, Katja [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Vienna (Austria); Bick, Ulrich; Fallenberg, Eva [Universitaetsmedizin Berlin, Clinic of Radiology, Charite, Berlin (Germany); Colin, Catherine [Centre Hospitalo-Universitaire Lyon Sud, Radiology Unit, Hospices Civils de Lyon, Pierre Benite Cedex (France); Cornford, Eleanor [Nottingham University Hospitals, Nottingham Breast Institute, Nottingham (United Kingdom); Evans, Andrew [Ninewells Hospital and Medical School, Dundee Cancer Centre, Clinical Research Centre, Dundee (United Kingdom); Forrai, Gabor [MHEK Teaching Hospital University Semmelweis, Budapest (Hungary); Fuchsjaeger, Michael H. [Medical University of Graz, Department of Radiology, Graz (Austria); Gilbert, Fiona J. [University of Cambridge, School of Clinical Medicine, Department of Radiology, Cambridge (United Kingdom); Heywang-Koebrunner, Sylvia H. [National Reference Centre Mammography, Munich, Munich (Germany); Camps-Herrero, Julia [Hospital de la Ribera, Department of Radiology, Alzira, Valencia (Spain); Kuhl, Christiane K. [University Hospital of Aachen, Rheinisch-Westfaelische Technische Hochschule, Aachen (Germany); Martincich, Laura [IRCCS-FPO, Radiology Unit, Candiolo, Turin (Italy); Pediconi, Federica [Sapienza University, Department of Radiological, Oncological and Pathological Sciences, Rome (Italy); Panizza, Pietro [Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Radiology 1, Milan (Italy); Pina, Luis J. [Clinica Universidad de Navarra, Department of Radiology, Pamplona, Navarra (Spain); Pijnappel, Ruud M. [University Medical Centre Utrecht, Department of Imaging, Utrecht (Netherlands); Skaane, Per [Oslo University Hospital Ullevaal, University of Oslo, Department of Radiology, Oslo (Norway); Sardanelli, Francesco [Universita degli Studi di Milano, Radiology Unit, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, San Donato Milanese, Milan (Italy); Collaboration: for the European Society of Breast Imaging (EUSOBI), with language review by Europa Donna-The European Breast Cancer Coalition

2015-12-15

This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADS registered categories and further actions after a breast MRI examination are discussed. Breast MRI is a very sensitive modality, significantly improving screening in high-risk women. It also has a role in clinical diagnosis, problem solving, and staging, impacting on patient management. However, it is not a perfect test, and occasionally breast cancers can be missed. Therefore, clinical and other imaging findings (from mammography/ultrasound) should also be considered. Conversely, MRI may detect lesions not visible on other imaging modalities turning out to be benign (false positives). These risks should be discussed with women before a breast MRI is requested/performed. Because breast MRI drawbacks depend upon the indication for the examination, basic information for the most important breast MRI indications is presented. Seventeen notes and five frequently asked questions formulated for use as direct communication to women are provided. The text was reviewed by Europa Donna-The European Breast Cancer Coalition to ensure that it can be easily understood by women undergoing MRI. (orig.)

Relationship between preoperative breast MRI and surgical treatment of non-metastatic breast cancer.

Science.gov (United States)

Onega, Tracy; Weiss, Julie E; Goodrich, Martha E; Zhu, Weiwei; DeMartini, Wendy B; Kerlikowske, Karla; Ozanne, Elissa; Tosteson, Anna N A; Henderson, Louise M; Buist, Diana S M; Wernli, Karen J; Herschorn, Sally D; Hotaling, Elise; O'Donoghue, Cristina; Hubbard, Rebecca

2017-12-01

More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established. Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery ± radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals. Of the 13 097 women, 2217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction. Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation. © 2017 Wiley Periodicals, Inc.

Comparison between breast MRI and contrast-enhanced spectral mammography.

Science.gov (United States)

Łuczyńska, Elżbieta; Heinze-Paluchowska, Sylwia; Hendrick, Edward; Dyczek, Sonia; Ryś, Janusz; Herman, Krzysztof; Blecharz, Paweł; Jakubowicz, Jerzy

2015-05-12

The main goal of this study was to compare contrast-enhanced spectral mammography (CESM) and breast magnetic resonance imaging (MRI) with histopathological results and to compare the sensitivity, accuracy, and positive and negative predictive values for both imaging modalities. After ethics approval, CESM and MRI examinations were performed in 102 patients who had suspicious lesions described in conventional mammography. All visible lesions were evaluated independently by 2 experienced radiologists using BI-RADS classifications (scale 1-5). Dimensions of lesions measured with each modality were compared to postoperative histopathology results. There were 102 patients entered into CESM/MRI studies and 118 lesions were identified by the combination of CESM and breast MRI. Histopathology confirmed that 81 of 118 lesions were malignant and 37 were benign. Of the 81 malignant lesions, 72 were invasive cancers and 9 were in situ cancers. Sensitivity was 100% with CESM and 93% with breast MRI. Accuracy was 79% with CESM and 73% with breast MRI. ROC curve areas based on BI-RADS were 0.83 for CESM and 0.84 for breast MRI. Lesion size estimates on CESM and breast MRI were similar, both slightly larger than those from histopathology. Our results indicate that CESM has the potential to be a valuable diagnostic method that enables accurate detection of malignant breast lesions, has high negative predictive value, and a false-positive rate similar to that of breast MRI.

A Dosimetric Comparison of Accelerated Partial Breast Irradiation Techniques: Multicatheter Interstitial Brachytherapy, Three-Dimensional Conformal Radiotherapy, and Supine Versus Prone Helical Tomotherapy

International Nuclear Information System (INIS)

Patel, Rakesh R.; Becker, Stewart J.; Das, Rupak K.; Mackie, Thomas R.

2007-01-01

Purpose: To compare dosimetrically four different techniques of accelerated partial breast irradiation (APBI) in the same patient. Methods and Materials: Thirteen post-lumpectomy interstitial brachytherapy (IB) patients underwent imaging with preimplant computed tomography (CT) in the prone and supine position. These CT scans were then used to generate three-dimensional conformal radiotherapy (3D-CRT) and prone and supine helical tomotherapy (PT and ST, respectively) APBI plans and compared with the treated IB plans. Dose-volume histogram analysis and the mean dose (NTD mean ) values were compared. Results: Planning target volume coverage was excellent for all methods. Statistical significance was considered to be a p value mean dose of 1.3 Gy 3 and 1.2 Gy 3 , respectively. Both of these methods were statistically significantly lower than the supine external beam techniques. Overall, all four methods yielded similar low doses to the heart. Conclusions: The use of IB and PT resulted in greater normal tissue sparing (especially ipsilateral breast and lung) than the use of supine external beam techniques of 3D-CRT or ST. However, the choice of APBI technique must be tailored to the patient's anatomy, lumpectomy cavity location, and overall treatment goals

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

International Nuclear Information System (INIS)

Kirby, Anna M.; Evans, Philip M.; Donovan, Ellen M.; Convery, Helen M.; Haviland, Joanna S.; Yarnold, John R.

2010-01-01

Purpose: To compare non-target tissue (including left-anterior-descending coronary-artery (LAD)) dosimetry of prone versus supine whole (WBI) and partial-breast irradiation (PBI). Methods and materials: Sixty-five post-lumpectomy breast cancer patients underwent CT-imaging supine and prone. On each dataset, the whole-breast clinical-target-volume (WB-CTV), partial-breast CTV (tumour-bed + 15 mm), ipsilateral-lung and chest-wall were outlined. Heart and LAD were outlined in left-sided cases (n = 30). Tangential-field WBI and PBI plans were generated for each position. Mean LAD, heart, and ipsilateral-lung doses (x mean ), maximum LAD (LAD max ) doses, and the volume of chest-wall receiving 50 Gy (V 50Gy ) were compared. Results: Two-hundred and sixty plans were generated. Prone positioning reduced heart and LAD doses in 19/30 WBI cases (median reduction in LAD mean = 6.2 Gy) and 7/30 PBI cases (median reduction in LAD max = 29.3 Gy) (no difference in 4/30 cases). However, prone positioning increased cardiac doses in 8/30 WBI (median increase in LAD mean = 9.5 Gy) and 19/30 PBI cases (median increase in LAD max = 22.9 Gy) (no difference in 3/30 cases). WB-CTV > 1000cm 3 was associated with improved cardiac dosimetry in the prone position for WBI (p = 0.04) and PBI (p = 0.04). Prone positioning reduced ipsilateral-lung mean in 65/65 WBI and 61/65 PBI cases, and chest-wall V 50Gy in all WBI cases. PBI reduced normal-tissue doses compared to WBI in all cases, regardless of the treatment position. Conclusions: In the context of tangential-field WBI and PBI, prone positioning is likely to benefit left-breast-affected women of larger breast volume, but to be detrimental in left-breast-affected women of smaller breast volume. Right-breast-affected women are likely to benefit from prone positioning regardless of breast volume.

Diagnostic value of dynamic and morphologic breast MRI analysis in the diagnosis of breast cancer

International Nuclear Information System (INIS)

Stusińska, Małgorzata; Szabo-Moskal, Jadwiga; Bobek-Billewicz, Barbara

2014-01-01

Mammography is the most widely used method of breast imaging. However, its low sensitivity poses a problem. Breast MRI is one of so the called “complementary” breast imaging methods. The purpose of this study was to improve the specificity of breast MRI by combining 2 methods: dynamic and morphologic analysis of enhancing lesions. 222 women aged 19–76 years, who underwent breast MRI examination between November 2002 and April 2004 at the Radiology Department of Oncology Center in Bydgoszcz, were included in this study. The pathological examination revealed cancer in 55 women (25%). No cancer was found in 167 women (75%), 56 of which were verified pathologically, 111 by cytology and/or during follow-up (at least 24 months). Results of breast MRI were positive in 80 women (36%), in 54 of which cancer was found during pathological examination, 26 breast MRI results were false positive. Sensitivity and specificity of breast MRI for dynamic analysis were 87% and 72%, respectively; in case of morphologic analysis 98% and 74%, respectively. The combined dynamic and morphologic analysis achieved high (84%) specificity without loss of sensitivity (98%). The difference in specificity between the evaluated methods was statistically significant (p<0.05). The combined dynamic and morphologic breast MRI analysis is a useful method for the diagnosis of breast cancer

Incidental extra-mammary findings in breast MRI

International Nuclear Information System (INIS)

Alduk, A.M.; Prutki, M.; Stern-Padovan, R.

2015-01-01

Aim: To investigate the frequency, distribution, and nature of incidental extra-mammary findings detected with breast MRI. Materials and methods: Incidental findings were defined as unexpected lesions outside the breast, not previously known or suspected at the time of referral. Five hundred consecutive breast MRI studies performed from June 2010 to September 2012 were reviewed in this retrospective study for which the institutional review board granted approval and waived the requirement for informed consent. MRI findings were compared with subsequent diagnostic procedures in order to differentiate benign from malignant lesions. Results: One hundred and thirty-eight incidental findings were found in 107 of the 500 (21.4%) examined patients. The most common site was the liver (61/138; 44.2%), followed by the lung (24/138; 17.4%), mediastinum (22/138; 15.9%), pleural cavity (15/138; 10.9%), bone tissue (9/138; 6.5%), spleen (3/138; 2.2%), major pectoral muscle (3/138; 2.2%), and kidney (1/138; 0.7%). Twenty-five of the 138 (18.1%) incidental findings were confirmed to be malignant, whereas the remaining 113 (81.9%) were benign. Malignant findings were exclusively detected in patients with known breast carcinoma, whereas incidental findings in patients without a history of carcinoma were all benign. Twenty-five of 100 (24.8%) incidental findings among patients with history of breast cancer were malignant. Conclusion: Although many of incidental findings were benign, some were malignant, altering the diagnostic work-up, staging, and treatment. Therefore, it is important to assess the entire field of view carefully for abnormalities when reviewing breast MRI studies. - Highlights: • 500 consecutive breast MRI studies were retrospectively reviewed. • Incidental findings were found in 107/500 (21.4%) of examined patients. • Incidental extra-mammary findings on breast MRI are common. • Malignant findings were exclusively detected in patients with known breast

Background parenchymal enhancement on breast MRI and mammographic breast density: correlation with tumour characteristics

International Nuclear Information System (INIS)

Kim, M.Y.; Choi, N.; Yang, J.-H.; Yoo, Y.B.; Park, K.S.

2015-01-01

Aim: To investigate the relationship between mammographic breast density (MGD) and background parenchymal enhancement (BPE) at breast MRI and histopathological features of invasive breast cancers. Materials and methods: A total of 178 women with unilateral invasive breast cancer who preoperatively underwent mammography and breast MRI were included in the study. Two radiologists rated MGD and BPE according to BI-RADS criteria in consensus. The relationship between MGD and BPE was investigated, and compared with histopathological features of invasive breast cancers according to the level of MGD and BPE. Results: At MRI, there is no significant difference in the distribution of MGD and BPE of the contralateral breast in women with invasive breast cancer according to menopausal status (p=0.226, 0.384). Women with high MGD (>50% glandular) were more likely to have oestrogen-receptor (ER)-positive breast cancer (p=0.045) and progesterone receptor (PR)-positive breast cancer (p=0.020). With regard to BPE, PR positivity correlated with moderate or marked BPE with borderline significance (p=0.054). Multivariate logistic regression analyses revealed that women with high MGD were less likely to have triple-negative (i.e., a cancer that is ER negative, PR negative, and human epidermal growth factor receptor type 2 [HER2] negative) breast cancer compared with ER (+)/HER2 (−) cancer (OR=0.231, 95% CI: 0.070, 0.760; p=0.016). No association between the histological tumour characteristics and BPE was observed. Conclusion: In women with invasive breast cancer, high MGD is associated with ER positivity of the invasive breast cancer. However, at MRI, BPE of the contralateral breast seems to be independent of tumour characteristics. -- Highlights: •There is no difference in distribution of MGD and BPE of contralateral breast on MRI. •High MGD is associated with ER positivity of the invasive breast cancer. •BPE of the contralateral breast on MRI is independent of tumor

Technical Note: Multipurpose CT, ultrasound, and MRI breast phantom for use in radiotherapy and minimally invasive interventions

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Ruschin, Mark, E-mail: Mark.Ruschin@sunnybrook.ca; Chin, Lee; Ravi, Ananth; McCann, Claire [Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Ontario M4N 3M5, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M4N 3M5 (Canada); Davidson, Sean R. H. [Techna Institute, University Health Network, Toronto, Ontario M5G 1P5 (Canada); Phounsy, William [Department of Physics, Ryerson University, Toronto, Ontario M5B 2K3 (Canada); Yoo, Tae Sun [Institute of Health Policy, University of Toronto, Toronto, Ontario M5T 3M6 (Canada); Pignol, Jean-Philippe [Department of Radiation Oncology, Erasmus MC Cancer Institute, 3075 EA Rotterdam (Netherlands)

2016-05-15

Purpose: To develop a multipurpose gel-based breast phantom consisting of a simulated tumor with realistic imaging properties in CT, ultrasound and MRI, or a postsurgical cavity on CT. Applications for the phantom include: deformable image registration (DIR) quality assurance (QA), autosegmentation validation, and localization testing and training for minimally invasive image-guided procedures such as those involving catheter or needle insertion. Methods: A thermoplastic mask of a typical breast patient lying supine was generated and then filled to make an array of phantoms. The background simulated breast tissue consisted of 32.4 g each of ballistic gelatin (BG) powder and Metamusil™ (MM) dissolved in 800 ml of water. Simulated tumors were added using the following recipe: 12 g of barium sulfate (1.4% v/v) plus 0.000 14 g copper sulfate plus 0.7 g of MM plus 7.2 g of BG all dissolved in 75 ml of water. The phantom was evaluated quantitatively in CT by comparing Hounsfield units (HUs) with actual breast tissue. For ultrasound and MRI, the phantoms were assessed based on subjective image quality and signal-difference to noise (SDNR) ratio, respectively. The stiffness of the phantom was evaluated based on ultrasound elastography measurements to yield an average Young’s modulus. In addition, subjective tactile assessment of phantom was performed under needle insertion. Results: The simulated breast tissue had a mean background value of 24 HU on CT imaging, which more closely resembles fibroglandular tissue (40 HU) as opposed to adipose (−100 HU). The tumor had a mean CT number of 45 HU, which yielded a qualitatively realistic image contrast relative to the background either as an intact tumor or postsurgical cavity. The tumor appeared qualitatively realistic on ultrasound images, exhibiting hypoechoic characteristics compared to background. On MRI, the tumor exhibited a SDNR of 3.7. The average Young’s modulus was computed to be 15.8 ± 0.7 kPa (1 SD

Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI

International Nuclear Information System (INIS)

Morakkabati-Spitz, N.; Leutner, C.; Schild, H.; Traeber, F.; Kuhl, C.

2005-01-01

The aim of this study was the evaluation of the diagnostic usefulness of ductal or segmental enhancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging finding is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unselected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients undergoing bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients' final diagnoses were established by imaging guided excisional or core biopsy or by clinical plus conventional imaging follow-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for patients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mammogram. The overall

A functional MRI Exploration of Hamstring Activation During the Supine Bridge Exercise.

Science.gov (United States)

Bourne, Matthew; Williams, Morgan; Pizzari, Tania; Shield, Anthony

2018-02-01

The single leg supine bridge (SLB) is a commonly employed strengthening exercise and is used as a clinical test for hamstring function in sports, however, little is known about the patterns of muscle activation in this task. To explore these activation patterns, nine healthy, recreationally active males underwent functional magnetic resonance imaging (fMRI) of their thighs at rest and immediately after 5 sets of 10 repetitions of the SLB exercise. Exercise-induced increases in the transverse (T2) relaxation time of the biceps femoris long and short heads, semitendinosus and semimembranosus, were determined via signal intensity changes in pre- and post-exercise images and used as an index of muscle activation. The Bonferroni adjusted alpha was set at phamstring injury prevention and rehabilitation programs. © Georg Thieme Verlag KG Stuttgart · New York.

Risk-benefit analysis of preoperative breast MRI in patients with primary breast cancer

International Nuclear Information System (INIS)

Siegmann, K.C.; Baur, A.; Vogel, U.; Kraemer, B.; Hahn, M.; Claussen, C.D.

2009-01-01

Aim: To analyse and compare the risks and benefits of preoperative breast MRI (BMRI) in patients with primary breast cancer (PBC), and to determine the influence of mammographic breast density (BD) and histological tumour type (TT). Materials and Methods: One hundred and nineteen patients who underwent preoperative bilateral breast MRI for staging of PBC during a 1-year period from July 2005 to August 2006 were prospectively evaluated. Changes in clinical management due to BMRI findings were recorded. MRI-detected lesions were correlated with histology. Additional MRI-detected malignant lesions and spared additional biopsies because of negative MRI in case of unclear ultrasound findings were determined as beneficial for the patient. Biopsies of benign MRI detected lesions were defined as disadvantageous. The influence of BD (ACR 1-4) and TT on the change in clinical management and patient benefit was evaluated. Results: The findings of the BMRI examinations changed the clinical management in 48 patients (40.3%). Seventeen women underwent mastectomy instead of breast conservation, eight patients underwent extended excision, 21 additional lesions were clarified by MRI intervention, and two ultrasound-detected lesions were not biopsied because of negative MRI. Histologically malignant additional or extended biopsies (n = 34) and two cases of spared biopsies resulted in 36 (30.3%) women who benefited from preoperative BMRI. Twelve patients (10.1%) had additional biopsies of MRI-detected benign lesions, and therefore, had an unfavourable outcome due to BMRI. The change in clinical management and patient benefit were independent of BD and TT (p > 0.05). Conclusion: Preoperative BMRI was beneficial for 30.3% of 119 patients with PBC. The percentage of additional biopsies of benign lesions (10.1%) seems acceptable

The role of magnetic resonance imaging (MRI) and MRI-guided surgery in the evaluation of patients with early stage breast cancer for breast conserving therapy

International Nuclear Information System (INIS)

Tan, Jacqueline E.; Orel, Susan G.; Schnall, Mitchell D.; Solin, Lawrence J.

1997-01-01

Purpose: Mammography is the primary imaging modality for the detection of breast cancer and the evaluation of patients with early stage breast cancer for breast conserving therapy (BCT). MRI may be more sensitive than mammography for detecting breast cancer and may have an adjunctive role in assessing patients with early stage disease for BCT. Our experience with 83 patients undergoing breast MRI during consideration for breast conserving therapy is analyzed. Materials and Methods: We reviewed 83 consecutive cases of patients undergoing breast MRI during standard work-up and evaluation for BCT from 1993 to 1996. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, or II and who received definitive therapy at our institution. All patients signed informed consent. MRI of the breast was performed at 1.5 Tesla. Sagittal T1 and T2 and 3-D gradient pre- and post-contrast images were obtained. All MRI studies were reviewed by two radiologists. All patients were evaluated by one radiation oncologist. The records of these 83 patients were reviewed for patient age, tumor size, AJCC stage, histology, physical examination findings, mammographic findings, ultrasound findings, MRI findings, timing of first MRI study with respect to excisional surgery, findings from MRI-guided surgery (when done), and whether the patient underwent BCT. Results: The median age at the time of presentation was 51.5 years (range 26-77 years). Of the 83 patients, 16% were AJCC clinical stage 0, 65% were stage I, and 19% were stage II. No patient presented with synchronous bilateral carcinoma. Two patients had a history of prior contralateral breast carcinoma; both received BCT for their initial disease. Sixteen percent of patients had intraductal carcinoma, 39% had intraductal and infiltrating carcinoma, 28% had infiltrating ductal carcinoma, 7% had infiltrating lobular carcinoma, 4% had tubular carcinoma, 2% had adenoid cystic carcinoma, 2% had medullary carcinoma, 1% had colloid

Value of breast MRI as supplement to mammography and sonography for high risk breast cancer patients

International Nuclear Information System (INIS)

Schlossbauer, T.; Hellerhoff, K.; Reiser, M.

2008-01-01

The aim of this study is to give an overview on early detection of breast cancer in patients with an increased risk of breast cancer. Sensitivities and diagnostic accuracies of breast MRI, mammography and ultrasound were compared. A systematic literature search of the past 3 years was performed. Studies which compared breast imaging modalities and used image-guided biopsy results as standard of reference were included. Patients included had to have had an increased lifetime risk for breast cancer (>15%). Regarding sensitivity and diagnostic accuracy, breast MRI performed best in comparison to the other modalities within this collective of patients. Sensitivities ranged from 71-100%, 0-78%, and 13-65%, for MRI, mammography, and ultrasound, respectively Breast MRI is a well established tool for screening in patients at high risk for developing breast cancer and is a valuable supplement to mammography and ultrasound within this selected cohort of patients. (orig.) [de

Agreement of mammographic measures of volumetric breast density to MRI.

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Jeff Wang

Full Text Available Clinical scores of mammographic breast density are highly subjective. Automated technologies for mammography exist to quantify breast density objectively, but the technique that most accurately measures the quantity of breast fibroglandular tissue is not known.To compare the agreement of three automated mammographic techniques for measuring volumetric breast density with a quantitative volumetric MRI-based technique in a screening population.Women were selected from the UCSF Medical Center screening population that had received both a screening MRI and digital mammogram within one year of each other, had Breast Imaging Reporting and Data System (BI-RADS assessments of normal or benign finding, and no history of breast cancer or surgery. Agreement was assessed of three mammographic techniques (Single-energy X-ray Absorptiometry [SXA], Quantra, and Volpara with MRI for percent fibroglandular tissue volume, absolute fibroglandular tissue volume, and total breast volume.Among 99 women, the automated mammographic density techniques were correlated with MRI measures with R(2 values ranging from 0.40 (log fibroglandular volume to 0.91 (total breast volume. Substantial agreement measured by kappa statistic was found between all percent fibroglandular tissue measures (0.72 to 0.63, but only moderate agreement for log fibroglandular volumes. The kappa statistics for all percent density measures were highest in the comparisons of the SXA and MRI results. The largest error source between MRI and the mammography techniques was found to be differences in measures of total breast volume.Automated volumetric fibroglandular tissue measures from screening digital mammograms were in substantial agreement with MRI and if associated with breast cancer could be used in clinical practice to enhance risk assessment and prevention.

Agreement of mammographic measures of volumetric breast density to MRI.

Science.gov (United States)

Wang, Jeff; Azziz, Ania; Fan, Bo; Malkov, Serghei; Klifa, Catherine; Newitt, David; Yitta, Silaja; Hylton, Nola; Kerlikowske, Karla; Shepherd, John A

2013-01-01

Clinical scores of mammographic breast density are highly subjective. Automated technologies for mammography exist to quantify breast density objectively, but the technique that most accurately measures the quantity of breast fibroglandular tissue is not known. To compare the agreement of three automated mammographic techniques for measuring volumetric breast density with a quantitative volumetric MRI-based technique in a screening population. Women were selected from the UCSF Medical Center screening population that had received both a screening MRI and digital mammogram within one year of each other, had Breast Imaging Reporting and Data System (BI-RADS) assessments of normal or benign finding, and no history of breast cancer or surgery. Agreement was assessed of three mammographic techniques (Single-energy X-ray Absorptiometry [SXA], Quantra, and Volpara) with MRI for percent fibroglandular tissue volume, absolute fibroglandular tissue volume, and total breast volume. Among 99 women, the automated mammographic density techniques were correlated with MRI measures with R(2) values ranging from 0.40 (log fibroglandular volume) to 0.91 (total breast volume). Substantial agreement measured by kappa statistic was found between all percent fibroglandular tissue measures (0.72 to 0.63), but only moderate agreement for log fibroglandular volumes. The kappa statistics for all percent density measures were highest in the comparisons of the SXA and MRI results. The largest error source between MRI and the mammography techniques was found to be differences in measures of total breast volume. Automated volumetric fibroglandular tissue measures from screening digital mammograms were in substantial agreement with MRI and if associated with breast cancer could be used in clinical practice to enhance risk assessment and prevention.

MRI screening for breast cancer in women at high risk; is the Australian breast MRI screening access program addressing the needs of women at high risk of breast cancer?

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Schenberg, Tess [Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Mitchell, Gillian [Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria (Australia); Taylor, Donna [School of Surgery, University of Western Australia, Perth, Western Australia (Australia); Department of Radiology, Royal Perth Hospital, Perth, Western Australia (Australia); BreastScreen Western Australia, Adelaide Terrace, Perth, Western Australia (Australia); Saunders, Christobel [School of Surgery, University of Western Australia, Perth, Western Australia (Australia); Department of General Surgery, St John of God Hospital, Perth, Western Australia (Australia); Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)

2015-09-15

Breast magnetic resonance imaging (MRI) screening of women under 50 years old at high familial risk of breast cancer was given interim funding by Medicare in 2009 on the basis that a review would be undertaken. An updated literature review has been undertaken by the Medical Services Advisory Committee but there has been no assessment of the quality of the screening or other screening outcomes. This review examines the evidence basis of breast MRI screening and how this fits within an Australian context with the purpose of informing future modifications to the provision of Medicare-funded breast MRI screening in Australia. Issues discussed will include selection of high-risk women, the options for MRI screening frequency and measuring the outcomes of screening.

MRI screening for breast cancer in women at high risk; is the Australian breast MRI screening access program addressing the needs of women at high risk of breast cancer?

International Nuclear Information System (INIS)

Schenberg, Tess; Mitchell, Gillian; Taylor, Donna; Saunders, Christobel

2015-01-01

Breast magnetic resonance imaging (MRI) screening of women under 50 years old at high familial risk of breast cancer was given interim funding by Medicare in 2009 on the basis that a review would be undertaken. An updated literature review has been undertaken by the Medical Services Advisory Committee but there has been no assessment of the quality of the screening or other screening outcomes. This review examines the evidence basis of breast MRI screening and how this fits within an Australian context with the purpose of informing future modifications to the provision of Medicare-funded breast MRI screening in Australia. Issues discussed will include selection of high-risk women, the options for MRI screening frequency and measuring the outcomes of screening

Growth of breast cancer recurrences assessed by consecutive MRI

International Nuclear Information System (INIS)

Millet, Ingrid; Bouic-Pages, Emmanuelle; Hoa, Denis; Azria, David; Taourel, Patrice

2011-01-01

Women with a personal history of breast cancer have a high risk of developing an ipsi- or contralateral recurrence. We aimed to compare the growth rate of primary breast cancer and recurrences in women who had undergone prior breast magnetic resonance imaging (MRI). Three hundred and sixty-two women were diagnosed with breast cancer and had undergone breast MRI at the time of diagnosis in our institution (2005 - 2009). Among them, 37 had at least one prior breast MRI with the lesion being visible but not diagnosed as cancer. A linear regression of tumour volume measured on MRI scans and time data was performed using a generalized logistic model to calculate growth rates. The primary objective was to compare the tumour growth rate of patients with either primary breast cancer (no history of breast cancer) or ipsi- or contralateral recurrences of breast cancer. Twenty women had no history of breast cancer and 17 patients were diagnosed as recurrences (7 and 10 were ipsi- and contralateral, respectively). The tumour growth rate was higher in contralateral recurrences than in ipsilateral recurrences (growth rate [10 -3 days -1 ] 3.56 vs 1.38, p < .001) or primary cancer (3.56 vs 2.09, p = 0.01). Differences in tumour growth were not significant for other patient-, tumour- or treatment-related characteristics. These findings suggest that contralateral breast cancer presents accelerated growth compared to ipsilateral recurrences or primary breast events

Breast MRI used as a problem-solving tool reliably excludes malignancy

International Nuclear Information System (INIS)

Spick, Claudio; Szolar, Dieter H.M.; Preidler, Klaus W.; Tillich, Manfred; Reittner, Pia; Baltzer, Pascal A.

2015-01-01

Highlights: • Breast MRI reliably excludes malignancy in conventional BI-RADS 0 cases (NPV: 100%). • Malignancy rate in the BI-RADS 0 population is substantial with 13.5%. • Breast MRI used as a problem-solving tool reliably excludes malignancy. - Abstract: Purpose: To evaluate the diagnostic performance of breast MRI if used as a problem-solving tool in BI-RADS 0 cases. Material and methods: In this IRB-approved, single-center study, 687 women underwent high-resolution-3D, dynamic contrast-enhanced breast magnetic resonance imaging (MRI) between January 2012 and December 2012. Of these, we analyzed 111 consecutive patients (mean age, 51 ± 12 years; range, 20–83 years) categorized as BI-RADS 0. Breast MRI findings were stratified by clinical presentations, conventional imaging findings, and breast density. MRI results were compared to the reference standard, defined as histopathology or an imaging follow-up of at least 1 year. Results: One hundred eleven patients with BI-RADS 0 conventional imaging findings revealed 30 (27%) mammographic masses, 57 (51.4%) mammographic architectural distortions, five (4.5%) mammographic microcalcifications, 17 (15.3%) ultrasound-only findings, and two palpable findings without imaging correlates. There were 15 true-positive, 85 true-negative, 11 false-positive, and zero false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 100% (15/15), 88.5% (85/96), 57.7% (15/26), and 100% (85/85), respectively. Breast density and reasons for referral had no significant influence on the diagnostic performance of breast MRI (p > 0.05). Conclusion: Breast MRI reliably excludes malignancy in conventional BI-RADS 0 cases resulting in a NPV of 100% (85/85) and a PPV of 57.7% (15/26)

High-resolution MRI in detecting subareolar breast abscess.

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Fu, Peifen; Kurihara, Yasuyuki; Kanemaki, Yoshihide; Okamoto, Kyoko; Nakajima, Yasuo; Fukuda, Mamoru; Maeda, Ichiro

2007-06-01

Because subareolar breast abscess has a high recurrence rate, a more effective imaging technique is needed to comprehensively visualize the lesions and guide surgery. We performed a high-resolution MRI technique using a microscopy coil to reveal the characteristics and extent of subareolar breast abscess. High-resolution MRI has potential diagnostic value in subareolar breast abscess. This technique can be used to guide surgery with the aim of reducing the recurrence rate.

Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection

International Nuclear Information System (INIS)

Youk, J.H.; Son, E.J.; Kim, E.-K.; Kim, J.-A.; Kim, M.J.; Kwak, J.Y.; Lee, S.M.

2009-01-01

Aim: To determine the diagnostic performance of dynamic magnetic resonance imaging (MRI) for breast cancer in breasts augmented with liquid paraffin or silicone injection. Materials and methods: Among 62 patients with breast augmentation by liquid paraffin or silicone injection who had undergone dynamic breast MRI at our institution, 27 women, who had pathological diagnosis or at least 1-year MRI follow-up, were included in this retrospective study and their MRI images were reviewed. For enhancing lesions on MRI, the morphological features, enhancement kinetics, and BI-RADS assessment category were analysed. The lesion characteristics at MRI were correlated with the final diagnosis based on the histopathological result or at least 1-year MRI follow-up. Results: Of the 27 patients, 17 enhancing lesions in 13 patients were found on MRI. All six lesions that were confirmed as malignancy showed suspicious morphological findings and type 2 or 3 enhancement kinetics, assigned to BI-RADS category 4 or 5. Of the remaining 11 benign lesions, 10 showed benign-favouring morphological findings, and all showed type 1 enhancement kinetics, assigned to BI-RADS category 2 or 4. Conclusion: In patients with breasts injected with foreign material, MRI was used to successfully diagnose malignant breast lesions and could be the diagnostic method of choice. Analysis of the morphological and kinetic features at MRI in conjunction with clinical findings is essential.

Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

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Pengel, Kenneth E., E-mail: k.pengel@nki.nl [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Loo, Claudette E. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Wesseling, Jelle [Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Pijnappel, Ruud M. [Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Rutgers, Emiel J.Th. [Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

2014-02-15

Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.

Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

International Nuclear Information System (INIS)

Pengel, Kenneth E.; Loo, Claudette E.; Wesseling, Jelle; Pijnappel, Ruud M.; Rutgers, Emiel J.Th.; Gilhuijs, Kenneth G.A.

2014-01-01

Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted

Association between breast cancer, breast density, and body adiposity evaluated by MRI

International Nuclear Information System (INIS)

Zhu, Wenlian; Huang, Peng; Macura, Katarzyna J.; Artemov, Dmitri

2016-01-01

Despite the lack of reliable methods with which to measure breast density from 2D mammograms, numerous studies have demonstrated a positive association between breast cancer and breast density. The goal of this study was to study the association between breast cancer and body adiposity, as well as breast density quantitatively assessed from 3D MRI breast images. Breast density was calculated from 3D T1-weighted MRI images. The thickness of the upper abdominal adipose layer was used as a surrogate marker for body adiposity. We evaluated the correlation between breast density, age, body adiposity, and breast cancer. Breast density was calculated for 410 patients with unilateral invasive breast cancer, 73 patients with ductal carcinoma in situ (DCIS), and 361 controls without breast cancer. Breast density was inversely related to age and the thickness of the upper abdominal adipose layer. Breast cancer was only positively associated with body adiposity and age. Age and body adiposity are predictive of breast density. Breast cancer was not associated with breast density; however, it was associated with the thickness of the upper abdominal adipose layer, a surrogate marker for body adiposity. Our results based on a limited number of patients warrant further investigations. (orig.)

Application of functional MRI in breast diseases

International Nuclear Information System (INIS)

Feng Yun; Liu Shiyuan; Wang Chenguang; Tao Xiaofeng; Wang Jinlin; Wang Jian

2007-01-01

Objective: To investigate the value of functional MRI in the diagnosis and differential diagnosis of breast diseases. Methods: Sixty-five patients with 68 lesions were enrolled in this study. Conventional T 1 WI and T 2 WI scan, dynamic contrast enhanced MRI, diffusion weighted imaging and 1 H single voxel MR spectroscopy were performed consequently. All lesions were verified by pathology, including 4 cases of breast adenosis, 22 fibroadenomas, 2 chronic inflammations, 3 cysts, 33 infitrating ductal carcinomas, 1 intraductal carcinoma and 3 cystosarcoma phyllodes tumors. Morphological features, maximum enhancement ratio, time-intensity curve, apparent diffusion coefficient and Choline peak were analyzed. Results: The detection rates of T 1 WI and T 2 WI were 14.7% (n=10) and 51.5% (n=35). The sensitivity, specificity, accuracy of dynamic contrast enhanced MRI for the malignant tumor were 94. 6%, 71.4% and 76.5% respectively. Retrospective study showed that diffusion weighted imaging, with the b value from 800 s/mm 2 to 1000 s/mm 2 , could be used to differentiate various types of breast lesions. 1 H signal voxel spectroscopy had a sensitivity of 51.4%, specificity of 82.6%, and accuracy of 67.6% for the malignent. The sensitivity, specificity and accuracy could reach 97.3%, 90.0% and 92.6% respectively by combining conventional scan, dynamic contrast enhanced MRI and MR spectroscopy. Conclusion: Functional MRI, with high sensitivity, specificity and accuracy, can be used widely in the diagnosis of malignant breast lesions. (authors)

Incidental dose to coronary arteries is higher in prone than in supine whole breast irradiation. A dosimetric comparison in adjuvant radiotherapy of early stage breast cancer

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Wuerschmidt, Florian; Stoltenberg, Solveigh; Kretschmer, Matthias; Petersen, Cordula

2014-06-15

Sparing of normal lung is best achieved in prone whole breast irradiation (WBI). However, exposure of the heart and coronary arteries might increase due to anterior movement of the heart in prone WBI. Treatment plans of 46 patients with large breasts irradiated for mammary cancer after breast-conserving surgery were retrospectively analyzed. The average treated breast volume of right-sided breasts (n = 33) was 1,804 ccm and 1,500 ccm for left-sided breasts (n = 13). The majority had invasive cancer (96 %) of which 61 % were pT1 and 39 % pT2 tumors. All patients received radiation therapy to the breast only. For three-dimensional (3D) treatment planning, all patients underwent a noncontrast-enhanced CT in the supine position with a wingboard and a second CT in the prone position using a prone breastboard. Nontarget volumes of the lung, heart, and coronary arteries were contoured. A total dose of 50.4 Gy was prescribed to the breast only. Differences were calculated for each patient and compared using the Wilcoxon signed-rank test. Treatment of left-sided breasts resulted in similar average mean heart doses in prone versus supine WBI (4.16 vs. 4.01 Gy; p = 0.70). The left anterior descending artery (LAD) had significantly higher dose exposure in left versus right WBI independent of position. Prone WBI always resulted in significantly higher exposures of the right circumflex artery (RCA) and LAD as compared to supine WBI. In left WBI, the mean LADprone was 33.5 Gy vs. LADsupine of 25.6 Gy (p = 0.0051). The V20prone of the LAD was 73.6 % vs. V20supine 50.4 % (p = 0.0006). The heart dose is not different between supine and prone WBI. However, in left WBI the incidental dose to the LAD with clinically relevant doses can be significantly higher in prone WBI. This is discussed controversially in the literature as it might depend on contouring and treatment techniques. We recommend contouring of LAD if patients are treated in prone WBI and evaluation of alternative

Clinical Study Pathologic Findings in MRI-Guided Needle Core Biopsies of the Breast in Patients with Newly Diagnosed Breast Cancer

International Nuclear Information System (INIS)

Siziopikou, K.P.; Jokich, P.; Cobleigh, M.

2011-01-01

The role of MRI in the management of breast carcinoma is rapidly evolving from its initial use for specific indications only to a more widespread use on all women with newly diagnosed early stage breast cancer. However, there are many concerns that such widespread use is premature since detailed correlation of MRI findings with the underlying histopathology of the breast lesions is still evolving and clear evidence for improvements in management and overall prognosis of breast cancer patients evaluated by breast MRI after their initial cancer diagnosis is lacking. In this paper, we would like to bring attention to a benign lesion that is frequently present on MRI-guided breast biopsies performed on suspicious MRI findings in the affected breast of patients with a new diagnosis of breast carcinoma

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

International Nuclear Information System (INIS)

Fischer, Uwe; Baum, Friedemann; Heyden, Dorit von; Zachariae, Olivier; Liersch, Torsten; Funke, Matthias

2004-01-01

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/90diam.; 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

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

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Fischer, Uwe; Baum, Friedemann; Heyden, Dorit von [Diagnostisches Brustzentrum Goettingen, Womens Health Care Center Goettingen, Bahnhofsallee 1d, 37081 Goettingen (Germany); Zachariae, Olivier; Liersch, Torsten [Department of General Surgery, Georg-August-University of Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen (Germany); Funke, Matthias [Department of Radiology, Georg-August-University of Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen (Germany)

2004-10-01

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{sup o}; 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.

Correlativity study on MRI morphologic features, pathology, and molecular biology of breast cancer

International Nuclear Information System (INIS)

Chen Rong; Gong Shuigen; Zhang Weiguo; Chen Jinhua; He Shuangwu; Liu Baohua; Li Zengpeng

2004-01-01

Objective: To investigate the correlation among MRI morphologic features, pathology, and molecular biology of breast cancer. Methods: MR scanning was performed in 78 patients with breast cancer before operation and MRI morphologic features of breast cancer were analyzed. The mastectomy specimens of the breast neoplasm were stained with immunohistochemistry, and the expression of estrogen receptor (ER), progesterone receptor (PR), C-erbB-2, p53, and the distribution of microvessel density (MVD) was measured. The pathologic results were compared with MRI features. Results: Among the 80 breast cancers, ER positive expression was positively correlated with the spiculate margin of breast cancer (P 0.05). Among the 41 breast cancers with dynamic MR scans, there was positive correlation between the spatial distribution of contrast agent and MVD (P<0.01). Conclusion: There exists some correlation among MRI morphologic features, pathology, and molecular biology factors in breast cancer to certain extent. The biologic behavior and prognosis of the breast cancer can be assessed according to MRI features

Management of breast lesions detectable only on MRI; Abklaerung ausschliesslich MRT-detektierbarer Mammalaesionen

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Siegmann-Luz, K.C.; Bahrs, S.D.; Preibsch, H.; Hattermann, V.; Claussen, C.D. [Universitaetsklinikum Tuebingen (Germany). Abt. Diagnostische und Interventionelle Radiologie

2014-01-15

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline 'Diagnosis, Therapy, and Follow-Up of Breast Cancer' as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. (orig.)

Let's go out of the breast: prevalence of extra-mammary findings and their characterization on breast MRI.

Science.gov (United States)

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-06-01

The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions. A retrospective review of 308 female patients (mean age 50 ± 20) who underwent breast MRI with 1.5T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n=80; follow-up n=45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n=80; dense breast n=103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT). 59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%. Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Abbreviated Breast MRI and Digital Tomosynthesis Mammography in Screening Women With Dense Breasts | Division of Cancer Prevention

Science.gov (United States)

This randomized phase II trial studies how well abbreviated breast magnetic resonance imaging (MRI) and digital tomosynthesis mammography work in detecting cancer in women with dense breasts. Abbreviated breast MRI is a low cost procedure in which radio waves and a powerful magnet linked to a computer and used to create detailed pictures of the breast in less than 10 minutes.

[Radiologic follow-up after breast-conserving surgery: value of MRI examination of the breast].

Science.gov (United States)

Polgár, C; Forrai, G; Szabó, E; Riedl, E; Fodor, J; Fornet, B; Németh, G

1999-11-21

The aim of the study was to establish an objective method for evaluation the extent, topography and quantity of skin and soft tissue side effects after tele- and/or brachyradiotherapy of the conserved breast and to compare the sequales of different radiation methods. 26 patients operated on for T1-2 N0-1 breast cancer underwent the following kinds of postoperative radiotherapy: 1. 46-50 Gy whole breast teletherapy + 10-16 Gy electron boost (5 patients), 2. 46-50 Gy teletherapy + 10-15 Gy HDR brachytherapy boost (12 patients), 3. 46-50 Gy teletherapy (6 patients), 4. 36,4 Gy sole HDR brachytherapy of the tumour bed (5 patients). The postirradiation side effects were examined by MRI, mammogram, US and physical examination, as well. MRI was performed on a 0.5 T, double breast coil, with SE-T1, SE-T2 and 3D-GE sequences. The findings of MRI and mammography were compared to physically detectable side effects using the RTOG/EORTC late radiation morbidity scoring scheme. US is useful in the measurement of skin thickening and in the diagnosis of fat necrosis. Mammography and physical examination are very subjective and low specificity methods to evaluate postirradiation side effects. MRI is a suitable and more objective method to detect the real extent and quantity of skin thickening and fibrosis. The incidence of > or = G2 side effects of skin and breast parenchyma were 64.5 and 32.2%, respectively. The differences between the side effects of whole breast irradiation and sole brachytherapy of the tumour bed are also clearly demonstrated. Brachytherapy alone is feasible without compromising cosmetic results. The authors established the MRI criteria for categorization the extent and grade of skin thickening and fibrosis (focal vs diffuse, grade 1-4). Breast MRI is an objective tool for assisting to the evaluation of the side effects of postoperative radiotherapy.

Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing: A Cross-Sectional MRI Study.

Science.gov (United States)

Hansen, Bjarke B; Bendix, Tom; Grindsted, Jacob; Bliddal, Henning; Christensen, Robin; Hansen, Philip; Riis, Robert G C; Boesen, Mikael

2015-11-01

Cross-sectional study. To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). The lumbar lordosis increases with a change of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75 (±5.0) mm during activities, and 38 healthy controls were included. MRI findings were common in both groups, whereas, the summation of the Pfirrmann's grades (LDD-score) was significantly higher in the patients [(MD 1.44; 95% confidence intervals (CI) 0.80 to 2.10; P lordosis between the positions may be independent of pain. Decreasing lordosis change seems to be associated with age-related increasing disc degeneration in healthy individuals. 2.

MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

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Choi, Hye Young [Department of Radiology, Gyeongsang National University Hospital, Jinju 660-702 (Korea, Republic of); Kim, Sun Mi; Jang, Mijung; Yun, Bo La [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Kim, Sung-Won; Kang, Eunyoung [Department of Surgery, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Park, So Yeon [Department of Pathology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Moon, Woo Kyung [Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of); Ko, Eun Sook [Department of Radiology, Samsung Medical Center, Seoul 135-710 (Korea, Republic of)

2013-07-01

To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.

MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

International Nuclear Information System (INIS)

Choi, Hye Young; Kim, Sun Mi; Jang, Mijung; Yun, Bo La; Kim, Sung-Won; Kang, Eunyoung; Park, So Yeon; Moon, Woo Kyung; Ko, Eun Sook

2013-01-01

To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions

Let's go out of the breast: Prevalence of extra-mammary findings and their characterization on breast MRI

International Nuclear Information System (INIS)

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-01-01

Purpose: The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions. Materials and methods: A retrospective review of 308 female patients (mean age 50 ± 20) who underwent breast MRI with 1.5 T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n = 80; follow-up n = 45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n = 80; dense breast n = 103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT). Results: 59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%. Conclusion: Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value

Let's go out of the breast: Prevalence of extra-mammary findings and their characterization on breast MRI

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Moschetta, Marco, E-mail: marco.moschetta@gmail.com; Telegrafo, Michele, E-mail: mikitele@hotmail.it; Rella, Leonarda, E-mail: lea.rella@gmail.com; Stabile Ianora, Amato Antonio, E-mail: a.stabile@radiologia.uniba.it; Angelelli, Giuseppe, E-mail: g.angellelli@radiologia.uniba.it

2014-06-15

Purpose: The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions. Materials and methods: A retrospective review of 308 female patients (mean age 50 ± 20) who underwent breast MRI with 1.5 T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n = 80; follow-up n = 45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n = 80; dense breast n = 103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT). Results: 59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%. Conclusion: Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value.

Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast. A comparative study with MRI

International Nuclear Information System (INIS)

Kim, Bom Sahn

2012-01-01

The aim of this study was to evaluate the adjunctive benefits of breast-specific gamma imaging (BSGI) versus magnetic resonance imaging (MRI) in breast cancer patients with dense breasts. This study included a total of 66 patients (44.1±8.2 years) with dense breasts (breast density >50%) and already biopsy-confirmed breast cancer. All of the patients underwent BSGI and MRI as part of an adjunct modality before the initial therapy. Of 66 patients, the 97 undetermined breast lesions were newly detected and correlated with the biopsy results. Twenty-six of the 97 breast lesions proved to be malignant tumors (invasive ductal cancer, n=16; ductal carcinoma in situ, n=6; mixed or other malignancies, n=4); the remaining 71 lesions were diagnosed as benign tumors. The sensitivity and specificity of BSGI were 88.8% (confidence interval (CI), 69.8-97.6%) and 90.1% (CI, 80.7-95.9%), respectively, while the sensitivity and specificity of MRI were 92.3% (CI, 74.9-99.1%) and 39.4% (CI, 28.0-51.7%), respectively (p<0.0001). MRI detected 43 false-positive breast lesions, 37 (86.0%) of which were correctly diagnosed as benign lesions using BSGI. In 12 malignant lesions <1 cm, the sensitivities of BSGI and MR imaging were 83.3% (CI, 51.6-97.9%) and 91.7% (CI, 61.5-99.8%), respectively. BSGI showed an equivocal sensitivity and a high specificity compared to MRI in the diagnosis of breast lesions. In addition, BSGI had a good sensitivity in discriminating breast cancers ≤1 cm. The results of this study suggest that BSGI could play a crucial role as an adjunctive imaging modality which can be used to evaluate breast cancer patients with dense breasts. (author)

Abbreviated protocol for breast MRI: Are multiple sequences needed for cancer detection?

International Nuclear Information System (INIS)

Mango, Victoria L.; Morris, Elizabeth A.; David Dershaw, D.; Abramson, Andrea; Fry, Charles; Moskowitz, Chaya S.; Hughes, Mary; Kaplan, Jennifer; Jochelson, Maxine S.

2015-01-01

Highlights: • Abbreviated breast MR demonstrates high sensitivity for breast carcinoma detection. • Time to perform/interpret the abbreviated exam is shorter than a standard MRI exam. • An abbreviated breast MRI could reduce costs and make MRI screening more available. - Abstract: Objective: To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1W) image and single early post-contrast T1W image, to detect breast carcinoma. Materials and methods: A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences. Results: All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p = 0.471, p = 0.656, p = 0.139). Mean interpretation time was 44 s (range 11–167 s). The abbreviated imaging protocol could be performed in approximately 10–15 min, compared to 30–40 min for the standard protocol. Conclusion: An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1W sequence may be adequate for detecting

Abbreviated protocol for breast MRI: Are multiple sequences needed for cancer detection?

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Mango, Victoria L., E-mail: vlm2125@columbia.edu [Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, New York, NY 10032 (United States); Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Morris, Elizabeth A., E-mail: morrise@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); David Dershaw, D., E-mail: dershawd@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Abramson, Andrea, E-mail: abramsoa@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Fry, Charles, E-mail: charles_fry@nymc.edu [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595 (United States); Moskowitz, Chaya S. [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Hughes, Mary, E-mail: hughesm@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Kaplan, Jennifer, E-mail: kaplanj@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States); Jochelson, Maxine S., E-mail: jochelsm@mskcc.org [Memorial Sloan-Kettering Cancer Center, Breast and Imaging Center, 300 East 66th Street, New York, NY 10065 (United States)

2015-01-15

Highlights: • Abbreviated breast MR demonstrates high sensitivity for breast carcinoma detection. • Time to perform/interpret the abbreviated exam is shorter than a standard MRI exam. • An abbreviated breast MRI could reduce costs and make MRI screening more available. - Abstract: Objective: To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1W) image and single early post-contrast T1W image, to detect breast carcinoma. Materials and methods: A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences. Results: All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p = 0.471, p = 0.656, p = 0.139). Mean interpretation time was 44 s (range 11–167 s). The abbreviated imaging protocol could be performed in approximately 10–15 min, compared to 30–40 min for the standard protocol. Conclusion: An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1W sequence may be adequate for detecting

Novel techniques for 7 tesla breast MRI

NARCIS (Netherlands)

van der Velden, T.A.

2017-01-01

This thesis introduced several new techniques to the field of 7 tesla breast MRI, enabling high field multi-parametric MR imaging and, potentially, patient specific treatment planning. Chapter 2 described the development of a RF coil setup for bilateral breast MR imaging and 31P spectroscopy. This

Abbreviated MRI protocols for detecting breast cancer in women with dense breasts

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Chen, Shung Qing; Huang, Min; Shen, Yu Ying; Liu, Chen Lu; Xu, Chuan Xiao [The Affiliated Suzhou Hospital, Nanjing Medical University, Suzhou (China)

2017-06-15

To evaluate the validity of two abbreviated protocols (AP) of MRI in breast cancer screening of dense breast tissue. This was a retrospective study in 356 participants with dense breast tissue and negative mammography results. The study was approved by the Nanjing Medical University Ethics Committee. Patients were imaged with a full diagnostic protocol (FDP) of MRI. Two APs (AP-1 consisting of the first post-contrast subtracted [FAST] and maximum-intensity projection [MIP] images, and AP-2 consisting of AP-1 combined with diffusion-weighted imaging [DWI]) and FDP images were analyzed separately, and the sensitivities and specificities of breast cancer detection were calculated. Of the 356 women, 67 lesions were detected in 67 women (18.8%) by standard MR protocol, and histological examination revealed 14 malignant lesions and 53 benign lesions. The average interpretation time of AP-1 and AP-2 were 37 seconds and 54 seconds, respectively, while the average interpretation time of the FDP was 3 minutes and 25 seconds. The sensitivities of the AP-1, AP-2, and FDP were 92.9, 100, and 100%, respectively, and the specificities of the three MR protocols were 86.5, 95.0, and 96.8%, respectively. There was no significant difference among the three MR protocols in the diagnosis of breast cancer (p > 0.05). However, the specificity of AP-1 was significantly lower than that of AP-2 (p = 0.031) and FDP (p = 0.035), while there was no difference between AP-2 and FDP (p > 0.05). The AP may be efficient in the breast cancer screening of dense breast tissue. FAST and MIP images combined with DWI of MRI are helpful to improve the specificity of breast cancer detection.

A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years with Invasive Breast Cancer

Directory of Open Access Journals (Sweden)

Som D. Mukherjee

2016-01-01

Full Text Available Introduction Breast magnetic resonance imaging (MRI is considered a more sensitive diagnostic test for detecting invasive breast cancer than mammography or breast ultrasound. Breast MRI may be particularly useful in younger premenopausal women with higher density breast tissue for differentiating between dense fibroglandular breast tissue and breast malignancies. The main objective of this study was to determine the impact of preoperative breast MRI on surgical decision-making in young women with breast cancer. Methods A retrospective review of patients with newly diagnosed invasive breast cancer and age of ≤50 years was performed. All patients underwent physical examination, preoperative mammogram, breast ultrasound, and bilateral breast MRI. Two breast cancer surgeons reviewed the preoperative mammogram report, breast ultrasound report, and physical examination summary and were asked if they would recommend a lumpectomy, a quandrantectomy, or a mastectomy. A few weeks later, the two surgeons were shown the same information with the breast MRI report and were asked what type of surgery they would now recommend. In each case, MRI was classified by two adjudicators as having affected the surgical outcome in a positive, negative, or neutral fashion. A positive impact was defined as the situation where breast MRI detected additional disease that was not found on physical examination, mammogram, or breast ultrasound and led to an appropriate change in surgical management. A negative impact was defined as the situation where breast MRI led the surgeon to recommend more extensive surgery, with less extensive disease actually found at pathology. No impact was defined as the situation where MRI findings did not alter surgical recommendations or outcomes. Results Of 37 patients whose charts were reviewed, five patients were deemed to be ineligible due to having received neoadjuvant chemotherapy, having previous breast implants, or having had their

Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions.

Science.gov (United States)

Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe; Moschetta, Marco

2015-10-01

To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard. Two hundred eighty consecutive patients (age range, 27-73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI. UE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found. Breast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization. Copyright © 2015 Elsevier Inc. All rights reserved.

A Case Report of Breast Sparganosis in a Patient with Ipsilateral Breast Cancer: MRI and Ultrasonographic Findings

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Lee, Yoo Jin; Bae, Young Tae; Kim, Jee Yeon [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Choo, Ki Seok [Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

2010-12-15

Sparganosis of the breast is a quite rare parasitic infection of humans and presents as soft tissue masses that mimic breast malignancy or benign tumor, such as fibroadenoma. We present here a case of histologically confirmed breast sparganosis in the upper inner quadrant of the right breast with coexisting breast cancer in the ipsilateral breast upper outer quadrant. Ultrasonography of breast sparganosis showed a well defined, tubular hypoechoic mass with discrete multilayered wall and tubule-in tubule appearance, surrounded by heterogenous hyperechoic areas in the subcutaneous fat layer of the breast. MRI revealed an elongated tubular structure with persistent and progressive enhancement. This is the second report concerned with the MRI and ultrasonographic findings of breast sparganosis and the first report of breast sparganosis in a patient with ipsilateral breast cancer

Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI.

Science.gov (United States)

Uematsu, Takayoshi

2013-12-01

To report on our initial experiences with a new method of real-time virtual sonography (RVS)-guided 11-gauge vacuum-assisted breast biopsy for lesions that were initially detected with breast MRI. RVS-guided 11-gauge vacuum-assisted biopsy is performed when a lesion with suspicious characteristics is initially detected with breast MRI and is occult on mammography, sonography, and physical examination. Live sonographic images were co-registered to the previously loaded second-look spine contrast-enhanced breast MRI volume data to correlate the sonography and MR images. Six lesions were examined in six consecutive patients scheduled to undergo RVS-guided 11-gauge vacuum-assisted biopsy. One patient was removed from the study because of non-visualization of the lesion in the second-look spine contrast-enhanced breast MRI. Five patients with non-mass enhancement lesions were biopsied. The lesions ranged in size from 9 to 13 mm (mean 11 mm). The average procedural time, including the sonography and MR image co-registration time, was 25 min. All biopsies resulted in tissue retrieval. One was fibroadenomatous nodules, and those of four were fibrocystic changes. There were no complications during or after the procedures. RVS-guided 11-gauge vacuum-assisted breast biopsies provide a safe and effective method for the examination of suspicious lesions initially detected with MRI.

Quantitative breast density analysis using tomosynthesis and comparison with MRI and digital mammography.

Science.gov (United States)

Moon, Woo Kyung; Chang, Jie-Fan; Lo, Chung-Ming; Chang, Jung Min; Lee, Su Hyun; Shin, Sung Ui; Huang, Chiun-Sheng; Chang, Ruey-Feng

2018-02-01

Breast density at mammography has been used as markers of breast cancer risk. However, newly introduced tomosynthesis and computer-aided quantitative method could provide more reliable breast density evaluation. In the experiment, 98 tomosynthesis image volumes were obtained from 98 women. For each case, an automatic skin removal was used and followed by a fuzzy c-mean (FCM) classifier which separated the fibroglandular tissues from other tissues in breast area. Finally, percent of breast density and breast volume were calculated and the results were compared with MRI. In addition, the percent of breast density and breast area of digital mammography calculated using the software Cumulus (University of Toronto, Toronto, ON, Canada.) were also compared with 3-D modalities. Percent of breast density and breast volume, which were computed from tomosynthesis, MRI and digital mammography were 17.37% ± 4.39% and 607.12 cm 3  ± 323.01 cm 3 , 20.3% ± 8.6% and 537.59 cm 3  ± 287.74 cm 3 , and 12.03% ± 4.08%, respectively. There were significant correlations on breast density as well as volume between tomosynthesis and MRI (R = 0.482 and R = 0.805), tomosynthesis and breast density with breast area of digital mammography (R = 0.789 and R = 0.877), and MRI and breast density with breast area of digital mammography (R = 0.482 and R = 0.857) (all P values density and breast volume evaluated from tomosynthesis, MRI and breast density and breast area of digital mammographic images have significant correlations and indicate that tomosynthesis could provide useful 3-D information on breast density through proposed method. Copyright © 2017 Elsevier B.V. All rights reserved.

Breast MRI in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning?

Science.gov (United States)

Parvaiz, Muhammad Asad; Yang, Peiming; Razia, Eisha; Mascarenhas, Margaret; Deacon, Caroline; Matey, Pilar; Isgar, Brian; Sircar, Tapan

2016-01-01

Magnetic resonance imaging (MRI) is highly sensitive in detecting invasive lobular carcinoma (ILC) of the breast. In our institution, patients who are deemed to be suitable for breast conserving surgery (BCS) with unifocal small ILC on standard imaging are offered breast MRI to exclude multifocal and larger ILC. Our study investigates the usefulness of breast MRI in ILC. A prospective cohort study over a 58-month period, including all consecutive patients with ILC having breast MRI. Primary objective was to find out the proportion of ILC patients where preoperative MRI caused a change in the surgical treatment. Secondary objectives included finding mastectomy rate (initial & final), re-operation rate, cancer size correlation with different imaging modalities and final histopathology, loco-regional recurrence and disease-free survival. A total of 334 bilateral breast MRI were performed including 72 (21.5%) MRI for ILC patients. All these MRI were carried out within 2 week of patients given the diagnosis (median 5.5 days). Age range was 24-83 (median 56.5) years. Nineteen of 72 ILC patients (26.4%) had a change in their planned operation from BCS to a different operation owing to MRI findings (seven patients with multifocal cancers, 10 with significantly larger size of the cancer and two with contralateral malignancy). Initial mastectomy rate was 31.9%, final mastectomy rate was 36.1% and re-operation rate in BCS group was 18.3%. MRI correlated better with ILC histopathology cancer size than mammogram and ultrasound scans. There was no statistically significant difference (p = 0.999) between the cancer size on histology (median 23 mm) and MRI (median 25 mm). However, mammogram (median 17 mm) and ultrasound (median 14.5 mm) scans showed cancer sizes significantly different to final histology cancer size (p = 0.0008 and p = 0.0021 respectively). Over a 44 months median follow-up (range 27-85), 95.8% disease-free survival and 98.6% overall survival have been observed

Comparison of intraductal spread on dynamic contrast-enhanced MRI with clinicopathologic features in breast cancer

International Nuclear Information System (INIS)

Komatsu, Shuhei; Lee, Chol-Joo; Hosokawa, Yohei; Ichikawa, Daisuke; Hamashima, Takashi; Shirono, Koichi; Okabe, Harumi; Kurioka, Hideaki; Oka, Takahiro

2004-01-01

Contrast-enhanced magnetic resonance imaging (CE-MRI) has emerged as a new diagnostic technology in various breast cancer treatments. However, little is known about the correlation between intraductal spread on CE-MRI and clinicopathologic features. This study was designed to evaluate these correlations for the surgical planning of breast cancer. Twenty-six breast cancer lesions (in 26 female patients) treated by breast conserving surgery between March 2001 and March 2003 were evaluated retrospectively. CE-MRI was performed with a 1.5 T unit using a dedicated bilateral breast coil. In detecting intraductal spread of breast cancer, the sensitivity, specificity and accuracy of CE-MRI were 82.4%, 60.0% and 77.3%, respectively. On mammography (MMG), these were 21.1%, 100.0% and 42.3%, respectively. Therefore, CE-MRI has a higher sensitivity and accuracy, although with a lower specificity than MMG. Compared with breast cancer lesions without intraductal spread on CE-MRI, lesions with intraductal spread on CE-MRI were found more frequently in larger-sized tumors (P=0.0088). Preoperative evaluation for intraductal spread by CE-MRI should be more useful than by MMG for breast cancer. When making the surgical decision regarding excision range, particular attention should be paid to this consideration for patients with larger-sized cancer tumors. (author)

Magnetic Resonance Imaging (MRI and Spectroscopy (MRS in Breast Cancer

Directory of Open Access Journals (Sweden)

Uma Sharma

2008-01-01

Full Text Available Breast cancer is a major health problem in women and early detection is of prime importance. Breast magnetic resonance imaging (MRI provides both physical and physiologic tissue features that are useful in discriminating malignant from benign lesions. Contrast enhanced MRI is valuable for diagnosis of small tumors in dense breast and the structural and kinetic parameters improved the specificity of diagnosing benign from malignant lesions. It is a complimentary modality for preoperative staging, to follow response to therapy, to detect recurrences and for screening high risk women. Diffusion, perfusion and MR elastography have been applied to breast lesion characterization and show promise.In-vivo MR spectroscopy (MRS is a valuable method to obtain the biochemical status of normal and diseased tissues. Malignant tissues contain high concentration of choline containing compounds that can be used as a biochemical marker. MRS helps to increase the specificity of MRI in lesions larger than 1cm and to monitor the tumor response. Various MR techniques show promise primarily as adjunct to the existing standard detection techniques, and its acceptability as a screening method will increase if specificity can be improved. This review presents the progress made in different MRI and MRS techniques in breast cancer management.

Volume based DCE-MRI breast cancer detection with 3D visualization system

International Nuclear Information System (INIS)

Chia, F.K.; Sim, K.S.; Chong, S.S.; Tan, S.T.; Ting, H.Y.; Abbas, S.F.; Omar, S.

2011-01-01

In this paper, a computer aided design auto probing system is presented to detect breast lesions based on Dynamic contrast enhanced Magnetic resonance imaging (DCE-MRI) images. The system is proposed in order to aid the radiologists and doctors in the interpretation of MRI breast images and enhance the detection accuracy. A series of approaches are presented to enhance the detection accuracy and refine the breast region of interest (Roil) automatically. Besides, a semi-quantitative analysis is used to segment the breast lesions from selected breast Roil and classify the detected tumour is whether benign, suspicious or malignant. The entire breast Roil including the detected tumour will display in 3D. The methodology has been applied on 104 sets of digital imaging and communications in medicine (Dico) breast MRI datasets images. The biopsy results are verified by 2 radiologists from Hospital Malaysia. The experimental results are demonstrated the proposed scheme can precisely identify breast cancer regions with 93% accuracy. (author)

Association between mammogram density and background parenchymal enhancement of breast MRI

Science.gov (United States)

Aghaei, Faranak; Danala, Gopichandh; Wang, Yunzhi; Zarafshani, Ali; Qian, Wei; Liu, Hong; Zheng, Bin

2018-02-01

Breast density has been widely considered as an important risk factor for breast cancer. The purpose of this study is to examine the association between mammogram density results and background parenchymal enhancement (BPE) of breast MRI. A dataset involving breast MR images was acquired from 65 high-risk women. Based on mammography density (BIRADS) results, the dataset was divided into two groups of low and high breast density cases. The Low-Density group has 15 cases with mammographic density (BIRADS 1 and 2), while the High-density group includes 50 cases, which were rated by radiologists as mammographic density BIRADS 3 and 4. A computer-aided detection (CAD) scheme was applied to segment and register breast regions depicted on sequential images of breast MRI scans. CAD scheme computed 20 global BPE features from the entire two breast regions, separately from the left and right breast region, as well as from the bilateral difference between left and right breast regions. An image feature selection method namely, CFS method, was applied to remove the most redundant features and select optimal features from the initial feature pool. Then, a logistic regression classifier was built using the optimal features to predict the mammogram density from the BPE features. Using a leave-one-case-out validation method, the classifier yields the accuracy of 82% and area under ROC curve, AUC=0.81+/-0.09. Also, the box-plot based analysis shows a negative association between mammogram density results and BPE features in the MRI images. This study demonstrated a negative association between mammogram density and BPE of breast MRI images.

Using deep learning to segment breast and fibroglandular tissue in MRI volumes.

Science.gov (United States)

Dalmış, Mehmet Ufuk; Litjens, Geert; Holland, Katharina; Setio, Arnaud; Mann, Ritse; Karssemeijer, Nico; Gubern-Mérida, Albert

2017-02-01

Automated segmentation of breast and fibroglandular tissue (FGT) is required for various computer-aided applications of breast MRI. Traditional image analysis and computer vision techniques, such atlas, template matching, or, edge and surface detection, have been applied to solve this task. However, applicability of these methods is usually limited by the characteristics of the images used in the study datasets, while breast MRI varies with respect to the different MRI protocols used, in addition to the variability in breast shapes. All this variability, in addition to various MRI artifacts, makes it a challenging task to develop a robust breast and FGT segmentation method using traditional approaches. Therefore, in this study, we investigated the use of a deep-learning approach known as "U-net." We used a dataset of 66 breast MRI's randomly selected from our scientific archive, which includes five different MRI acquisition protocols and breasts from four breast density categories in a balanced distribution. To prepare reference segmentations, we manually segmented breast and FGT for all images using an in-house developed workstation. We experimented with the application of U-net in two different ways for breast and FGT segmentation. In the first method, following the same pipeline used in traditional approaches, we trained two consecutive (2C) U-nets: first for segmenting the breast in the whole MRI volume and the second for segmenting FGT inside the segmented breast. In the second method, we used a single 3-class (3C) U-net, which performs both tasks simultaneously by segmenting the volume into three regions: nonbreast, fat inside the breast, and FGT inside the breast. For comparison, we applied two existing and published methods to our dataset: an atlas-based method and a sheetness-based method. We used Dice Similarity Coefficient (DSC) to measure the performances of the automated methods, with respect to the manual segmentations. Additionally, we computed

Computerized Interpretation of Dynamic Breast MRI

Science.gov (United States)

2005-05-01

The interpretation criteria in the current literature fall Breast MRI has emerged as a promising modality for the into two major categories: 5’ 14...is that theraphy , current interpretation schemes might not be sufficiently ro- Despite its well-recognized advantages, applications of bust. MRI in...postcontrast series For the manual delineation, a radiologist (U.B.), blinded were then taken with a time interval of 60 s. Each series to the histological

Sensitivity of enhanced MRI for the detection of breast cancer: new, multicentric, residual, and recurrent

International Nuclear Information System (INIS)

Davis, P.L.; McCarty, K.S. Jr.

1997-01-01

Magnetic resonance imaging (MRI) of the breast brings the advantages of high resolution cross-sectional imaging to breast cancer diagnosis, treatment and research: improved cancer detection, staging, selection of therapy, evaluation of therapeutic response in vivo, detection of recurrence, and even the development of new therapies. Until now breast cancer treatment and research has been impeded by the limited means of evaluating the breast cancer in vivo: primarily clinical palpation and mammography of the breast tumor. A review of the initial studies shows that with the use of paramagnetic contrast agents, MRI has a sensitivity of 96 % for detecting breast cancers. MRI detects multicentric disease with a sensitivity of 98 %, superior to any other modality. The ability of MRI to detect recurrent local breast cancer in the conservatively treated breast is nearly 100 %. MRI is capable of monitoring tumor response to chemotherapy and actually guiding therapeutic interventions such as interstitial laser photocoagulation. (orig.)

Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related?

Science.gov (United States)

Onega, Tracy; Lee, Christoph I; Benkeser, David; Alford-Teaster, Jennifer; Haas, Jennifer S; Tosteson, Anna N A; Hill, Deirdre; Shi, Xun; Henderson, Louise M; Hubbard, Rebecca A

2016-06-01

Mammography, unlike MRI, is relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies on the basis of sociodemographic or breast cancer risk factors is unknown. The investigators examined screening mammography and MRI between 2005 and 2012 in the Breast Cancer Surveillance Consortium by (1) travel time to the closest and actual mammography facility used and the difference between the two, (2) women's breast cancer risk factors, and (3) sociodemographic characteristics. Logistic regression was used to examine the odds of traveling farther than the closest facility in relation to women's characteristics. Among 821,683 screening mammographic examinations, 76.6% occurred at the closest facility, compared with 51.9% of screening MRI studies (n = 3,687). The median differential travel time among women not using the closest facility for mammography was 14 min (interquartile range, 8-25 min) versus 20 min (interquartile range, 11-40 min) for breast MRI. Differential travel time for both imaging modalities did not vary notably by breast cancer risk factors but was significantly longer for nonurban residents. For non-Hispanic black compared with non-Hispanic white women, the adjusted odds of traveling farther than the closest facility were 9% lower for mammography (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) but more than two times higher for MRI (odds ratio, 2.64; 95% confidence interval, 1.36-5.13). Breast cancer risk factors were not related to excess travel time for screening MRI, but sociodemographic factors were, suggesting the possibility that geographic distribution of advanced imaging may exacerbated disparities for some vulnerable populations. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Preoperative breast MRI in patients with invasive lobular breast cancer

International Nuclear Information System (INIS)

Schelfout, K.; Colpaert, C.; Van Goethem, M.; Verslegers, I.; Biltjes, I.; De Schepper, A.; Kersschot, E.; Leyman, P.; Thienpont, L.; Van den Haute, J.; Gillardin, J.P.; Tjalma, W.; Buytaert, Ph.

2004-01-01

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC. (orig.)

Preoperative breast MRI in patients with invasive lobular breast cancer

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Schelfout, K.; Colpaert, C. [Department of Pathology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem (Belgium); Van Goethem, M.; Verslegers, I.; Biltjes, I.; De Schepper, A. [Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem (Belgium); Kersschot, E.; Leyman, P. [Department of Radiology, O.L.V. Hospital Aalst, Moorselbaan 164, 9000, Aalst (Belgium); Thienpont, L. [Department of Pathology, O.L.V. Hospital Aalst, Moorselbaan 164, 9000, Aalst (Belgium); Van den Haute, J. [Department of Gynecology, O.L.V. Hospital Aalst, Moorselbaan 164, 9000, Aalst (Belgium); Gillardin, J.P. [Department of Surgery, O.L.V. Hospital Aalst, Moorselbaan 164, 9000, Aalst (Belgium); Tjalma, W.; Buytaert, Ph. [Department of Gynecology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem (Belgium)

2004-07-01

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC. (orig.)

Usefulness of breast MRI for diagnosing an extensive intraductal component of breast cancer: comparison with mammography and ultrasonography

International Nuclear Information System (INIS)

Kim, Tae Hee; Kang, Doo Kyung; Jung, Yong Sik; Yim, Hyun Ee

2006-01-01

An extensive intraductal component of breast cancer is a principal risk factor for local recurrence, and this is difficult to diagnose with performing only mammography. We investigated the usefulness of breast MRI for evaluating an extensive intraductal component of breast cancer, and we compared this modality with mammography and ultrasonography (US). From March 2003 to July 2004, 90 patients underwent breast MRI among all the patients who were suffering with breast cancer and for whom and EIC was ultimately revealed to be present or not. A total 83 patients with stage I and II breast cancer were finally included in this study. EIC positivity was defined according to the imaging data as follows: 1) microcalcifications beyond the tumor shadow or malignant microcalcifications without a tumor mass on mammography, 2) tubular hypoechoic structures adjacent to the tumor or architectural distortion with calcifications beyond the tumor on US, and 3) linear or ductal enhancement, segmental or regional clumped enhancement, and spotty nodular or reticular enhancement adjacent to the tumor on MRI. EIC was present in 41 patients and this finding was negative in 42 patients. The results were then compared those results from mammography and US. The sensitivities of detecting EIC by mammography, US and MRI were 48.6%, 67.5% and 80.5%, respectively, and the corresponding specificities were 92.3%, 73.2% and 69.0%, respectively. In the cases that were suspected to be EIC positive on more than two imaging modality, the positive predictive value (PPV) was 78.1%. In cases that were suspected of being EIC positive on just one imaging modality, the negative predictive value (NPV) was 75.0%. Breast MRI provides good information about an EIC of breast cancer and it is a more sensitive study than mammography and US, yet the specificity for the detection of EIC is highest on mammography. A combined evaluation by mammography, US and MRI is the most accurate way to diagnose an EIC of breast

Fully automated chest wall line segmentation in breast MRI by using context information

Science.gov (United States)

Wu, Shandong; Weinstein, Susan P.; Conant, Emily F.; Localio, A. Russell; Schnall, Mitchell D.; Kontos, Despina

2012-03-01

Breast MRI has emerged as an effective modality for the clinical management of breast cancer. Evidence suggests that computer-aided applications can further improve the diagnostic accuracy of breast MRI. A critical and challenging first step for automated breast MRI analysis, is to separate the breast as an organ from the chest wall. Manual segmentation or user-assisted interactive tools are inefficient, tedious, and error-prone, which is prohibitively impractical for processing large amounts of data from clinical trials. To address this challenge, we developed a fully automated and robust computerized segmentation method that intensively utilizes context information of breast MR imaging and the breast tissue's morphological characteristics to accurately delineate the breast and chest wall boundary. A critical component is the joint application of anisotropic diffusion and bilateral image filtering to enhance the edge that corresponds to the chest wall line (CWL) and to reduce the effect of adjacent non-CWL tissues. A CWL voting algorithm is proposed based on CWL candidates yielded from multiple sequential MRI slices, in which a CWL representative is generated and used through a dynamic time warping (DTW) algorithm to filter out inferior candidates, leaving the optimal one. Our method is validated by a representative dataset of 20 3D unilateral breast MRI scans that span the full range of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) fibroglandular density categorization. A promising performance (average overlay percentage of 89.33%) is observed when the automated segmentation is compared to manually segmented ground truth obtained by an experienced breast imaging radiologist. The automated method runs time-efficiently at ~3 minutes for each breast MR image set (28 slices).

Fully automated deformable registration of breast DCE-MRI and PET/CT

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Dmitriev, I. D.; Loo, C. E.; Vogel, W. V.; Pengel, K. E.; Gilhuijs, K. G. A.

2013-02-01

Accurate characterization of breast tumors is important for the appropriate selection of therapy and monitoring of the response. For this purpose breast imaging and tissue biopsy are important aspects. In this study, a fully automated method for deformable registration of DCE-MRI and PET/CT of the breast is presented. The registration is performed using the CT component of the PET/CT and the pre-contrast T1-weighted non-fat suppressed MRI. Comparable patient setup protocols were used during the MRI and PET examinations in order to avoid having to make assumptions of biomedical properties of the breast during and after the application of chemotherapy. The registration uses a multi-resolution approach to speed up the process and to minimize the probability of converging to local minima. The validation was performed on 140 breasts (70 patients). From a total number of registration cases, 94.2% of the breasts were aligned within 4.0 mm accuracy (1 PET voxel). Fused information may be beneficial to obtain representative biopsy samples, which in turn will benefit the treatment of the patient.

Magnetic Resonance Imaging (MRI and Spectroscopy (MRS in Breast Cancer

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Uma Sharma

2008-01-01

Full Text Available Breast cancer is a major health problem in women and early detection is of prime importance. Breast magnetic resonance imaging (MRI provides both physical and physiologic tissue features that are useful in discriminating malignant from benign lesions. Contrast enhanced MRI is valuable for diagnosis of small tumors in dense breast and the structural and kinetic parameters improved the specificity of diagnosing benign from malignant lesions. It is a complimentary modality for preoperative staging, to follow response to therapy, to detect recurrences and for screening high risk women. Diffusion, perfusion and MR elastography have been applied to breast lesion characterization and show promise. In-vivo MR spectroscopy (MRS is a valuable method to obtain the biochemical status of normal and diseased tissues. Malignant tissues contain high concentration of choline containing compounds that can be used as a biochemical marker. MRS helps to increase the specificity of MRI in lesions larger than 1cm and to monitor the tumor response. Various MR techniques show promise primarily as adjunct to the existing standard detection techniques, and its acceptability as a screening method will increase if specificity can be improved. This review presents the progress made in different MRI and MRS techniques in beast cancer management.

A Cost Analysis of Preoperative Breast MRI Use for Patients with Invasive Lobular Cancer.

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Bedrosian, Isabelle; Xing, Yan; Abdel Rahman, Shereen; Allen, Lisa; Le-Petross, Huong; Whitman, Gary J; Meric-Bernstam, Funda; Hunt, Kelly K; Babiera, Gildy V; Cormier, Janice N

2016-01-01

Whereas the impact of magnetic resonance imaging (MRI) of the breast on the surgical management of breast cancer patients is well documented, less is known about its effect on health care costs. This study aimed to evaluate whether MRI use for women with invasive lobular carcinoma (ILC) significantly changes the cost of care. Patients with ILC were recruited to a prospective registry study of breast MRI. Women who met the same inclusion criteria but had not undergone breast MRI were retrospectively identified for comparison. A micro-costing analysis using institutional billing records was conducted. Nonparametric bootstrapping was used to compare the unadjusted cost differences between the patients receiving MRI and those receiving no MRI. Of the patients in this study, 51 had preoperative MRI, and 60 did not. Method of diagnostic biopsy, disease stage, oncologic procedure, and rates of contralateral prophylactic mastectomy were similar between the two groups. The patients in the MRI group were younger (median age 55 vs. 64 years; p = 0.01) and more likely to undergo reconstruction (45.1 vs. 25 %; p = 0.03). The median costs of care were significantly higher in the MRI group ($24,781 vs. $18,921; p 1; p < 0.01), and use of reconstruction (p < 0.01). Preoperative breast MRI increases the median total cost of care per patient. However, the contribution to the overall cost of care is modest compared with the cost of other interventions.

A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

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Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

2017-09-15

To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

Identification of Breast Cancer Using Integrated Information from MRI and Mammography.

Directory of Open Access Journals (Sweden)

Shih-Neng Yang

Full Text Available Integration of information from corresponding regions between the breast MRI and an X-ray mammogram could benefit the detection of breast cancer in clinical diagnosis. We aimed to provide a framework of registration from breast MRI to mammography and to evaluate the diagnosis using the combined information.43 patients with 46 lesions underwent both MRI and mammography scans, and the interval between the two examinations was around one month. The distribution of malignant to benign lesions was 31/46 based on histological results. Maximum intensity projection and thin-plate spline methods were applied for image registration for MRI to mammography. The diagnosis using integrated information was evaluated using results of histology as the reference. The assessment of annotations and statistical analysis were performed by the two radiologists.For the cranio-caudal view, the mean post-registration error between MRI and mammography was 2.2±1.9 mm. For the medio-lateral oblique view, the proposed approach performed even better with a mean error of 3.0±2.4 mm. In the diagnosis using MRI assessment with information of mammography, the sensitivity was 91.9±2.3% (29/31, 28/31, specificity 70.0±4.7% (11/15, 10/15, accuracy 84.8±3.1% (40/46, 38/46, positive predictive value 86.4±2.1% (29/33, 28/33 and negative predictive value 80.8±5.4% (11/13, 10/13.MRI with the aid of mammography shows potential improvements of sensitivity, specificity, accuracy, PPV and NPV in clinical breast cancer diagnosis compared to the use of MRI alone.

Radiomics for ultrafast dynamic contrast-enhanced breast MRI in the diagnosis of breast cancer: a pilot study

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Drukker, Karen; Anderson, Rachel; Edwards, Alexandra; Papaioannou, John; Pineda, Fred; Abe, Hiroyuke; Karzcmar, Gregory; Giger, Maryellen L.

2018-02-01

Radiomics for dynamic contrast-enhanced (DCE) breast MRI have shown promise in the diagnosis of breast cancer as applied to conventional DCE-MRI protocols. Here, we investigate the potential of using such radiomic features in the diagnosis of breast cancer applied on ultrafast breast MRI in which images are acquired every few seconds. The dataset consisted of 64 lesions (33 malignant and 31 benign) imaged with both `conventional' and ultrafast DCE-MRI. After automated lesion segmentation in each image sequence, we calculated 38 radiomic features categorized as describing size, shape, margin, enhancement-texture, kinetics, and enhancement variance kinetics. For each feature, we calculated the 95% confidence interval of the area under the ROC curve (AUC) to determine whether the performance of each feature in the task of distinguishing between malignant and benign lesions was better than random guessing. Subsequently, we assessed performance of radiomic signatures in 10-fold cross-validation repeated 10 times using a support vector machine with as input all the features as well as features by category. We found that many of the features remained useful (AUC>0.5) for the ultrafast protocol, with the exception of some features, e.g., those designed for latephase kinetics such as the washout rate. For ultrafast MRI, the radiomics enhancement-texture signature achieved the best performance, which was comparable to that of the kinetics signature for `conventional' DCE-MRI, both achieving AUC values of 0.71. Radiomic developed for `conventional' DCE-MRI shows promise for translation to the ultrafast protocol, where enhancement texture appears to play a dominant role.

MRI of the breast: does the internet accurately report its beneficial uses and limitations?

Science.gov (United States)

Nekhlyudov, Larissa; Kiarsis, Keith; Elmore, Joann G

2009-01-01

As consumer use of the Internet for medical information grows, continuing evaluation of the medical content on the Internet is needed. We evaluated Internet sites describing breast magnetic resonance imaging (MRI), an emerging technology tool in breast cancer diagnosis and screening. We searched Google for sites describing breast MRI and abstracted the affiliation, content, media type, readability, and quality of 90 most popular unique sites. Over half (56%) of the sites were commercially sponsored. The content varied by site and included medical and procedural facts, information about clinical trials, grants and journal articles, as well as human interest stories. Most (82%) sites described potentially beneficial uses of breast MRI, such as further evaluation of newly diagnosed breast cancers (58%); screening women at high risk for breast cancer (54%); evaluation of abnormal breast findings (48%); screening women with dense breasts (48%) or implants (27%); and surveillance for breast cancer recurrences (24%). Approximately half (56%) of the sites described the limitations of breast MRI, most commonly false positive findings (44%) and costs (24%). Website quality, including the display of contact information, sponsorship, currency of information, authorship, and references varied. The reading level was close to high school graduate. Internet sites describing breast MRI were mostly commercially sponsored, more often described the potential beneficial uses of the procedure than its limitations, and were of variable quality and high reading level. With the lack of enforceable standards for display of medical information on the Internet, providers should encourage patients to direct their searches to the most credible sites.

Preclinical study of diagnostic performances of contrast-enhanced spectral mammography versus MRI for breast diseases in China.

Science.gov (United States)

Wang, Qingguo; Li, Kangan; Wang, Lihui; Zhang, Jianbing; Zhou, Zhiguo; Feng, Yan

2016-01-01

To evaluate diagnostic performances of CESM for breast diseases with comparison to breast MRI in China. Sixty-eight patients with 77 breast lesions underwent MR and CESM. Two radiologists interpreted either MRI or CESM images, separately and independently. BI-RADS 1-3 and BI-RADS 4-5 were classified into the suspicious benign and suspicious malignant groups. Diagnostic accuracy parameters were calculated. Receiver operating characteristic (ROC) curves were constructed for the two modalities. The agreement and correlation between maximum lesion diameter based on CESM and MRI, or CESM and pathology were analyzed. Diagnostic accuracy parameters for CESM were sensitivity 95.8 %, specificity 65.5 %, PPV 82.1 %, NPV 90.5 % and accuracy 84.4 %. The diagnostic accuracy parameters for breast MRI were sensitivity 93.8 %, specificity 82.8 %, PPV 88.2 %, NPV 92.3 %and accuracy 89.6 %. Area under the curve (AUC) of ROC was 0.96 for breast MRI and 0.88 for CESM. The Bland-Altman plots showed a mean difference of 0.7 mm with 95 % limits of agreement of 11.4 mm in tumor diameter measured using CESM and breast MRI. The differences of size measurement between CESM and breast MRI were significant, whereas no difference was observed between CESM and pathology as well as between breast MRI and pathology. The better correlation with pathological results was found in CESM than breast MRI. Our study demonstrates that CESM possesses better diagnostic performances than breast MRI in terms of diagnostic sensitivity and lesion size assessment. And CESM is a good alternative method of screening breast cancer in high-risk people.

Screening for breast cancer with MRI: recent experience from the Australian Capital Territory

International Nuclear Information System (INIS)

Price, J.; Chen, S. W.

2009-01-01

Full text: The American Cancer Society now recommends annual MRI screening for women at 20-25% or greater lifetime risk of breast cancer. The role of MRI screening in other risk subgroups is unproved because of insufficient data. Our study comprised 209 breast MRI scans carried out in 171 asymptomatic patients (age range 22-67 years, mean 46 years), referred between January 2005 and June 2008. Targeted ultrasound was carried out in 32 episodes (15%) and biopsies were taken in 23 patients (13%). In four patients, MR-guided procedures were required to establish a diagnosis, two using hook-wire localization and two by means of vacuum-assisted biopsy. Seven cancers were detected by MRI in the 171 patients, with a yield of 4.1%. Only one of the seven cancers was also shown by x-ray mammography. Four patients had invasive ductal cancer (all axillary node negative) and three had high-grade ductal carcinoma in situ or pleomorphic lobular carcinoma in situ. The three women with in situ disease were all potentially high risk, based on the National Breast and Ovarian Cancer Centre (NBOCC) criteria. Three women with invasive breast cancer were at only average risk based on NBOCC criteria, but two of these had extremely dense breasts. A fourth patient, found to have multifocal invasive cancer, had a personal history of contralateral breast cancer, but no relevant family history. Our findings suggest that breast MRI could be used to screen a larger Australian population at increased risk of developing breast cancer.

Reporting and management of breast lesions detected using MRI

International Nuclear Information System (INIS)

Dall, B.J.G.; Vinnicombe, S.; Gilbert, F.J.

2011-01-01

Magnetic resonance imaging (MRI) is the most accurate technique for diagnosing and delineating the extent of both invasive and in-situ breast cancer and is increasingly being used as part of the preoperative work-up to assess the local extent of disease. It is proving invaluable in providing information that allows successful single-stage surgery. An inevitable consequence of the high sensitivity of MRI is that it will identify additional lesions that may or may not represent significant extra disease. This may complicate and delay the preoperative process. This paper outlines a strategy for managing MRI-detected lesions to optimize the benefits of breast MRI as a local staging tool while minimizing the false-positive diagnoses. It discusses the importance of good technique to reduce the number of indeterminate lesions. Methods to refine the patient pathway to minimize delays are discussed. The format of MRI reporting is discussed in detail as is the usefulness of discussion of cases at multidisciplinary meetings. Illustrative cases are used to clarify the points made.

MRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer.

Directory of Open Access Journals (Sweden)

Barbara Bennani-Baiti

Full Text Available Previously, a strong positive association between background parenchymal enhancement (BPE at magnetic resonance imaging (MRI and breast cancer was reported in high-risk populations. We sought to determine, whether this was also true for non-high-risk patients.540 consecutive patients underwent breast MRI for assessment of breast findings (BI-RADS 0-5, non-high-risk screening (no familial history of breast cancer, no known genetic mutation, no prior chest irradiation, or previous breast cancer diagnosis and subsequent histological work-up. For this IRB-approved study, BPE and fibroglandular tissue FGT were retrospectively assessed by two experienced radiologists according to the BI-RADS lexicon. Pearson correlation coefficients were calculated to explore associations between BPE, FGT, age and final diagnosis of breast cancer. Subsequently, multivariate logistic regression analysis, considering covariate colinearities, was performed, using final diagnosis as the target variable and BPE, FGT and age as covariates.Age showed a moderate negative correlation with FGT (r = -0.43, p<0.001 and a weak negative correlation with BPE (r = -0.28, p<0.001. FGT and BPE correlated moderately (r = 0.35, p<0.001. Final diagnosis of breast cancer displayed very weak negative correlations with FGT (r = -0.09, p = 0.046 and BPE (r = -0.156, p<0.001 and weak positive correlation with age (r = 0.353, p<0.001. On multivariate logistic regression analysis, the only independent covariate for prediction of breast cancer was age (OR 1.032, p<0.001.Based on our data, neither BPE nor FGT independently correlate with breast cancer risk in non-high-risk patients at MRI. Our model retained only age as an independent risk factor for breast cancer in this setting.

Quantitative Volumetric K-Means Cluster Segmentation of Fibroglandular Tissue and Skin in Breast MRI.

Science.gov (United States)

Niukkanen, Anton; Arponen, Otso; Nykänen, Aki; Masarwah, Amro; Sutela, Anna; Liimatainen, Timo; Vanninen, Ritva; Sudah, Mazen

2017-10-18

Mammographic breast density (MBD) is the most commonly used method to assess the volume of fibroglandular tissue (FGT). However, MRI could provide a clinically feasible and more accurate alternative. There were three aims in this study: (1) to evaluate a clinically feasible method to quantify FGT with MRI, (2) to assess the inter-rater agreement of MRI-based volumetric measurements and (3) to compare them to measurements acquired using digital mammography and 3D tomosynthesis. This retrospective study examined 72 women (mean age 52.4 ± 12.3 years) with 105 disease-free breasts undergoing diagnostic 3.0-T breast MRI and either digital mammography or tomosynthesis. Two observers analyzed MRI images for breast and FGT volumes and FGT-% from T1-weighted images (0.7-, 2.0-, and 4.0-mm-thick slices) using K-means clustering, data from histogram, and active contour algorithms. Reference values were obtained with Quantra software. Inter-rater agreement for MRI measurements made with 2-mm-thick slices was excellent: for FGT-%, r = 0.994 (95% CI 0.990-0.997); for breast volume, r = 0.985 (95% CI 0.934-0.994); and for FGT volume, r = 0.979 (95% CI 0.958-0.989). MRI-based FGT-% correlated strongly with MBD in mammography (r = 0.819-0.904, P K-means clustering-based assessments of the proportion of the fibroglandular tissue in the breast at MRI are highly reproducible. In the future, quantitative assessment of FGT-% to complement visual estimation of FGT should be performed on a more regular basis as it provides a component which can be incorporated into the individual's breast cancer risk stratification.

Should breast MRI be performed with adjustment for the phase in patients’ menstrual cycle? Correlation between mammographic density, age, and background enhancement on breast MRI without adjusting for the phase in patients’ menstrual cycle

International Nuclear Information System (INIS)

Uematsu, Takayoshi; Kasami, Masako; Watanabe, Junichiro

2012-01-01

Purpose: The purpose of this study was to assess the correlation between mammographic density, age, and background enhancement on breast MRI without adjusting for the phase in patients’ menstrual cycle. Material and methods: The background enhancement of bilateral breast MRI and the breast density of mammography in 146 consecutive women without adjusting for the phase in patients’ menstrual cycle were reviewed. The breast density was classified into four categories according to the American College of Radiology the Breast Imaging Reporting and Data System lexicon. The background enhancement was classified into four categories: minimal, mild, moderate, and marked. The correlations of mammographic breast density as well as age with background enhancement on breast MRI were examined. Results: There was a significant correlation between mammographic breast density and background enhancement (p = 0.011). All nine cases with almost completely fat mammographic breast density showed minimal (78%) or mild (12%) background enhancement on breast MRI. There was a significant inverse correlation between age and background enhancement (p < 0.0001). Younger patients with dense breasts were more likely to demonstrate moderate/marked background enhancement. Conclusion: When no adjusting for the phase in patients’ menstrual cycle, a significant correlation was observed between background enhancement and mammographic density. A significant inverse correlation was also observed between age and background enhancement.

Retrospective study comparing breast planning in supine and prone using Acess(Qfix); Estudo retrospectivo comparativo do planejamento de mama em posicao supina e a de prona com acessorio Acess-Qfix

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Setti, Marcela C.; Fernandes, Izabela L.S.; Padua, Marcelo L.A.; Cunha, Fredstone R. [Cot - Radioterapia, Uberlandia, MG (Brazil)

2016-07-01

Retrospective study comparing breast planning in supine and prone using Acess(Qfix) immobilization accessory. 10 participants were evaluated for the period from November 2015 to April 2016. In the comparative analysis of healthy organs heart, lung and healthy breast, lung had only difference with significance statistics. Regarding the coverage of the tumor volume and gradient there was also no statistically significant difference. (author)

Contrast-enhanced breast MRI: factors affecting sensitivity and specificity

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Piccoli, C.W. [Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, 132 South 10th Street, 7th floor, Philadelphia, PA 19107-5244 (United States)

1997-12-31

Contrast-enhanced MRI (CE-MRI) of the breast has been investigated for over 10 years. The reports of sensitivity for cancer detection have generally been greater than 90 %. However, estimates of specificity have varied greatly. Differing results are due to differences in study populations, technical methods and criteria for interpretation. Early and marked signal rise, detected using dynamic imaging technique following contrast administration, is the MRI hallmark of cancer. However, some malignant lesions may enhance slowly or minimally, and a variety of benign lesions may enhance rapidly with marked signal intensity. High resolution techniques generally requiring longer acquisition times are more likely to depict the slowly enhancing malignancies at the cost of a decrease in specificity due to lack of temporal resolution. This disadvantage may be offset by the improved visualization of lesion morphology with high resolution images. This report reviews the methods and results of the leading investigators of breast MRI. (orig.) With 3 figs., 70 refs.

Contrast-enhanced breast MRI: factors affecting sensitivity and specificity

International Nuclear Information System (INIS)

Piccoli, C.W.

1997-01-01

Contrast-enhanced MRI (CE-MRI) of the breast has been investigated for over 10 years. The reports of sensitivity for cancer detection have generally been greater than 90 %. However, estimates of specificity have varied greatly. Differing results are due to differences in study populations, technical methods and criteria for interpretation. Early and marked signal rise, detected using dynamic imaging technique following contrast administration, is the MRI hallmark of cancer. However, some malignant lesions may enhance slowly or minimally, and a variety of benign lesions may enhance rapidly with marked signal intensity. High resolution techniques generally requiring longer acquisition times are more likely to depict the slowly enhancing malignancies at the cost of a decrease in specificity due to lack of temporal resolution. This disadvantage may be offset by the improved visualization of lesion morphology with high resolution images. This report reviews the methods and results of the leading investigators of breast MRI. (orig.)

Comparative analysis of nonlinear dimensionality reduction techniques for breast MRI segmentation

Energy Technology Data Exchange (ETDEWEB)

Akhbardeh, Alireza; Jacobs, Michael A. [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 (United States); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 (United States) and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 (United States)

2012-04-15

Purpose: Visualization of anatomical structures using radiological imaging methods is an important tool in medicine to differentiate normal from pathological tissue and can generate large amounts of data for a radiologist to read. Integrating these large data sets is difficult and time-consuming. A new approach uses both supervised and unsupervised advanced machine learning techniques to visualize and segment radiological data. This study describes the application of a novel hybrid scheme, based on combining wavelet transform and nonlinear dimensionality reduction (NLDR) methods, to breast magnetic resonance imaging (MRI) data using three well-established NLDR techniques, namely, ISOMAP, local linear embedding (LLE), and diffusion maps (DfM), to perform a comparative performance analysis. Methods: Twenty-five breast lesion subjects were scanned using a 3T scanner. MRI sequences used were T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging. The hybrid scheme consisted of two steps: preprocessing and postprocessing of the data. The preprocessing step was applied for B{sub 1} inhomogeneity correction, image registration, and wavelet-based image compression to match and denoise the data. In the postprocessing step, MRI parameters were considered data dimensions and the NLDR-based hybrid approach was applied to integrate the MRI parameters into a single image, termed the embedded image. This was achieved by mapping all pixel intensities from the higher dimension to a lower dimensional (embedded) space. For validation, the authors compared the hybrid NLDR with linear methods of principal component analysis (PCA) and multidimensional scaling (MDS) using synthetic data. For the clinical application, the authors used breast MRI data, comparison was performed using the postcontrast DCE MRI image and evaluating the congruence of the segmented lesions. Results: The NLDR-based hybrid approach was able to define and segment

Comparative analysis of nonlinear dimensionality reduction techniques for breast MRI segmentation

International Nuclear Information System (INIS)

Akhbardeh, Alireza; Jacobs, Michael A.

2012-01-01

Purpose: Visualization of anatomical structures using radiological imaging methods is an important tool in medicine to differentiate normal from pathological tissue and can generate large amounts of data for a radiologist to read. Integrating these large data sets is difficult and time-consuming. A new approach uses both supervised and unsupervised advanced machine learning techniques to visualize and segment radiological data. This study describes the application of a novel hybrid scheme, based on combining wavelet transform and nonlinear dimensionality reduction (NLDR) methods, to breast magnetic resonance imaging (MRI) data using three well-established NLDR techniques, namely, ISOMAP, local linear embedding (LLE), and diffusion maps (DfM), to perform a comparative performance analysis. Methods: Twenty-five breast lesion subjects were scanned using a 3T scanner. MRI sequences used were T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging. The hybrid scheme consisted of two steps: preprocessing and postprocessing of the data. The preprocessing step was applied for B 1 inhomogeneity correction, image registration, and wavelet-based image compression to match and denoise the data. In the postprocessing step, MRI parameters were considered data dimensions and the NLDR-based hybrid approach was applied to integrate the MRI parameters into a single image, termed the embedded image. This was achieved by mapping all pixel intensities from the higher dimension to a lower dimensional (embedded) space. For validation, the authors compared the hybrid NLDR with linear methods of principal component analysis (PCA) and multidimensional scaling (MDS) using synthetic data. For the clinical application, the authors used breast MRI data, comparison was performed using the postcontrast DCE MRI image and evaluating the congruence of the segmented lesions. Results: The NLDR-based hybrid approach was able to define and segment both

Correlation between MRI results and intraoperative findings in patients with silicone breast implants

NARCIS (Netherlands)

N. Lindenblatt (Nicole); K. El-Rabadi (Karem); T. Helbich (Thomas); H. Czembirek (Heinrich); M. Deutinger (Maria); H. Benditte-Klepetko (Heike)

2014-01-01

textabstractBackground:Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture.

Real-time 3-dimensional virtual reality navigation system with open MRI for breast-conserving surgery

International Nuclear Information System (INIS)

Tomikawa, Morimasa; Konishi, Kozo; Ieiri, Satoshi; Hong, Jaesung; Uemura, Munenori; Hashizume, Makoto; Shiotani, Satoko; Tokunaga, Eriko; Maehara, Yoshihiko

2011-01-01

We report here the early experiences using a real-time three-dimensional (3D) virtual reality navigation system with open magnetic resonance imaging (MRI) for breast-conserving surgery (BCS). Two patients with a non-palpable MRI-detected breast tumor underwent BCS under the guidance of the navigation system. An initial MRI for the breast tumor using skin-affixed markers was performed immediately prior to excision. A percutaneous intramammary dye marker was applied to delineate an excision line, and the computer software '3D Slicer' generated a real-time 3D virtual reality model of the tumor and the puncture needle in the breast. Under guidance by the navigation system, marking procedures were performed without any difficulties. Fiducial registration errors were 3.00 mm for patient no.1, and 4.07 mm for patient no.2. The real-time 3D virtual reality navigation system with open MRI is feasible for safe and accurate excision of non-palpable MRI-detected breast tumors. (author)

Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer?

International Nuclear Information System (INIS)

Uematsu, Takayoshi; Kasami, Masako; Watanabe, Junichiro

2011-01-01

The purpose of this study was to assess the influence of background enhancement on the detection and staging of breast cancer using MRI as an adjunct to mammography or ultrasound. One hundred forty-six bilateral breast MRI examinations were evaluated to assess the extent of a known primary tumour and to problem solve after mammography or ultrasound without adjusting for the phase in the patients' menstrual cycle. The background enhancement was classified into four categories by visual evaluation: minimal, mild, moderate and marked. In total, 131 histologically confirmed abnormal cases (104 malignant and 27 benign) and 15 normal cases were included in the analysis. There was no tumour size-related bias between the groups (p = 0.522). For the primary index tumour, the sensitivities of MRI with minimal/mild and moderate/marked background enhancement were 100% and 76% (p = 0.001), respectively. Thus, the degree of background enhancement did not affect the specificity. For evaluating tumour extent (n = 104), the accuracy of MRI with moderate/marked background enhancement (52%) was significantly lower than that with minimal/mild background enhancement (84%; p = 0.002). The degree of background enhancement affected the detection and staging of breast cancer using MRI. (orig.)

Deformable Registration for Longitudinal Breast MRI Screening.

Science.gov (United States)

Mehrabian, Hatef; Richmond, Lara; Lu, Yingli; Martel, Anne L

2018-04-13

MRI screening of high-risk patients for breast cancer provides very high sensitivity, but with a high recall rate and negative biopsies. Comparing the current exam to prior exams reduces the number of follow-up procedures requested by radiologists. Such comparison, however, can be challenging due to the highly deformable nature of breast tissues. Automated co-registration of multiple scans has the potential to aid diagnosis by providing 3D images for side-by-side comparison and also for use in CAD systems. Although many deformable registration techniques exist, they generally have a large number of parameters that need to be optimized and validated for each new application. Here, we propose a framework for such optimization and also identify the optimal input parameter set for registration of 3D T 1 -weighted MRI of breast using Elastix, a widely used and freely available registration tool. A numerical simulation study was first conducted to model the breast tissue and its deformation through finite element (FE) modeling. This model generated the ground truth for evaluating the registration accuracy by providing the deformation of each voxel in the breast volume. An exhaustive search was performed over various values of 7 registration parameters (4050 different combinations of parameters were assessed) and the optimum parameter set was determined. This study showed that there was a large variation in the registration accuracy of different parameter sets ranging from 0.29 mm to 2.50 mm in median registration error and 3.71 mm to 8.90 mm in 95 percentile of the registration error. Mean registration errors of 0.32 mm, 0.29 mm, and 0.30 mm and 95 percentile errors of 3.71 mm, 5.02 mm, and 4.70 mm were obtained by the three best parameter sets. The optimal parameter set was applied to consecutive breast MRI scans of 13 patients. A radiologist identified 113 landmark pairs (~ 11 per patient) which were used to assess registration accuracy. The results demonstrated that

Breast MRI: EUSOBI recommendations for women's information

NARCIS (Netherlands)

Mann, R.M.; Balleyguier, C.; Baltzer, P.A.; Bick, U.; Colin, C.; Cornford, E.; Evans, A.; Fallenberg, E.; Forrai, G.; Fuchsjager, M.H.; Gilbert, F.J.; Helbich, T.H.; Heywang-Kobrunner, S.H.; Camps-Herrero, J.; Kuhl, C.K.; Martincich, L.; Pediconi, F.; Panizza, P.; Pina, L.J.; Pijnappel, R.M.; Pinker-Domenig, K.; Skaane, P.; Sardanelli, F.; Imaging, w.l.r.b.E.D.-T.E.B.C.C. European Societ

2015-01-01

This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADS(R)

Breast MRI : EUSOBI recommendations for women's information

NARCIS (Netherlands)

Mann, Ritse M.; Balleyguier, Corinne; Baltzer, Pascal A.; Bick, Ulrich; Colin, Catherine; Cornford, Eleanor; Evans, Andrew; Fallenberg, Eva; Forrai, Gabor; Fuchsjaeger, Michael H.; Gilbert, Fiona J.; Helbich, Thomas H.; Heywang-Koebrunner, Sylvia H.; Camps-Herrero, Julia; Kuhl, Christiane K.; Martincich, Laura; Pediconi, Federica; Panizza, Pietro; Pina, Luis J.; Pijnappel, Ruud M.; Pinker-Domenig, Katja; Skaane, Per; Sardanelli, Francesco

2015-01-01

This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADSA (R)

Role of pharmacokinetic parameters derived with high temporal resolution DCE MRI using simultaneous PET/MRI system in breast cancer: A feasibility study

Energy Technology Data Exchange (ETDEWEB)

Jena, Amarnath, E-mail: drjena2002@gmail.com [Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi–Mathura Road, New Delhi 110076 (India); Taneja, Sangeeta; Singh, Aru; Negi, Pradeep; Mehta, Shashi Bhushan [Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi–Mathura Road, New Delhi 110076 (India); Sarin, Ramesh [Department of Surgical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi–Mathura Road, New Delhi 110076 (India)

2017-01-15

Highlights: • Simultaneous PET/MRI (with 3T MRI in the core) for quantitative pharmacokinetics. • Diagnostic accuracy of pharmacokinetic parameters like K{sup trans}, K{sub ep} and v{sub e} acquired through this system. • Incorporating high temporal resolution sequence with short acquisition time of 60 s within the routine DCE MRI in a simultaneous PET/MRI system. - Abstract: Purpose: To evaluate the reliability of pharmacokinetic parameters like K{sup trans}, Kep and v{sub e} derived through DCE MRI breast protocol using 3 T Simultaneous PET/MRI (3 Tesla Positron Emission Tomography/Magnetic Resonance Imaging) system in distinguishing benign and malignant lesions. Materials and methods: High temporal resolution DCE (Dynamic Contrast Enhancement) MRI performed as routine breast MRI for diagnosis or as a part of PET/MRI for cancer staging using a 3 T simultaneous PET/MRI system in 98 women having 109 breast lesions were analyzed for calculation of pharmacokinetic parameters (K{sup trans}, v{sub e}, and Kep) at 60 s time point using an in-house developed computation scheme. Results: Receiver operating characteristic (ROC) curve analysis revealed a cut off value for K{sup trans}, Kep, v{sub e} as 0.50, 2.59, 0.15 respectively which reliably distinguished benign and malignant breast lesions. Data analysis revealed an overall accuracy of 94.50%, 79.82% and 87.16% for K{sup trans}, Kep, v{sub e} respectively. Introduction of native T1 normalization with an externally placed phantom showed a higher accuracy (94.50%) than without native T1 normalization (93.50%) with an increase in specificity of 87% vs 84%. Conclusion: Overall the results indicate that reliable measurement of pharmacokinetic parameters with reduced acquisition time is feasible in a 3TMRI embedded PET/MRI system with reasonable accuracy and application may be extended to exploit the potential of simultaneous PET/MRI in further work on breast cancer.

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions

International Nuclear Information System (INIS)

Mus, Roel D.; Borelli, Cristina; Bult, Peter; Weiland, Elisabeth; Karssemeijer, Nico; Barentsz, Jelle O.; Gubern-Mérida, Albert; Platel, Bram; Mann, Ritse M.

2017-01-01

Highlights: • New view-sharing sequences (e.g. TWIST) enable ultrafast dynamic breast MRI. • TWIST sequences accurately characterize the inflow of contrast in breast lesions. • TTE evaluation allows breast lesion classification with very high accuracy. • The use of TTE significantly increases the specificity of breast MRI. • TWIST imaging may increase the potential of breast MRI as screening tool. - Abstract: Objectives: To investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI). Methods: In this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0 × 0.9 × 2.5 mm, temporal resolution 4.32 s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied. Results: TTE had a significantly better discriminative ability than curve type (p < 0.001 and p = 0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p = 0.549 and p = 0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p < 0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ = 0.86) and substantial for conventional assessment (κ = 0.75). Conclusions: TTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions

Energy Technology Data Exchange (ETDEWEB)

Mus, Roel D., E-mail: aroel.mus@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Borelli, Cristina, E-mail: cristinaborelli@hotmail.it [Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia (Italy); Department of Radiology, Radboud University Medical Center (internal address 766), Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Bult, Peter, E-mail: peter.bult@radboudumc.nl [Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Weiland, Elisabeth, E-mail: elisabeth.weiland@siemens.com [Siemens Healthcare, Erlangen (Germany); Karssemeijer, Nico, E-mail: nico.karssemeijer@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Barentsz, Jelle O., E-mail: jelle.barentsz@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Gubern-Mérida, Albert, E-mail: albert.gubernmerida@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Platel, Bram, E-mail: bram.platel@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Mann, Ritse M., E-mail: ritse.mann@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands)

2017-04-15

Highlights: • New view-sharing sequences (e.g. TWIST) enable ultrafast dynamic breast MRI. • TWIST sequences accurately characterize the inflow of contrast in breast lesions. • TTE evaluation allows breast lesion classification with very high accuracy. • The use of TTE significantly increases the specificity of breast MRI. • TWIST imaging may increase the potential of breast MRI as screening tool. - Abstract: Objectives: To investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI). Methods: In this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0 × 0.9 × 2.5 mm, temporal resolution 4.32 s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied. Results: TTE had a significantly better discriminative ability than curve type (p < 0.001 and p = 0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p = 0.549 and p = 0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p < 0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ = 0.86) and substantial for conventional assessment (κ = 0.75). Conclusions: TTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high

Variability of non-Gaussian diffusion MRI and intravoxel incoherent motion (IVIM) measurements in the breast.

Science.gov (United States)

Iima, Mami; Kataoka, Masako; Kanao, Shotaro; Kawai, Makiko; Onishi, Natsuko; Koyasu, Sho; Murata, Katsutoshi; Ohashi, Akane; Sakaguchi, Rena; Togashi, Kaori

2018-01-01

We prospectively examined the variability of non-Gaussian diffusion magnetic resonance imaging (MRI) and intravoxel incoherent motion (IVIM) measurements with different numbers of b-values and excitations in normal breast tissue and breast lesions. Thirteen volunteers and fourteen patients with breast lesions (seven malignant, eight benign; one patient had bilateral lesions) were recruited in this prospective study (approved by the Internal Review Board). Diffusion-weighted MRI was performed with 16 b-values (0-2500 s/mm2 with one number of excitations [NEX]) and five b-values (0-2500 s/mm2, 3 NEX), using a 3T breast MRI. Intravoxel incoherent motion (flowing blood volume fraction [fIVIM] and pseudodiffusion coefficient [D*]) and non-Gaussian diffusion (theoretical apparent diffusion coefficient [ADC] at b value of 0 sec/mm2 [ADC0] and kurtosis [K]) parameters were estimated from IVIM and Kurtosis models using 16 b-values, and synthetic apparent diffusion coefficient (sADC) values were obtained from two key b-values. The variabilities between and within subjects and between different diffusion acquisition methods were estimated. There were no statistical differences in ADC0, K, or sADC values between the different b-values or NEX. A good agreement of diffusion parameters was observed between 16 b-values (one NEX), five b-values (one NEX), and five b-values (three NEX) in normal breast tissue or breast lesions. Insufficient agreement was observed for IVIM parameters. There were no statistical differences in the non-Gaussian diffusion MRI estimated values obtained from a different number of b-values or excitations in normal breast tissue or breast lesions. These data suggest that a limited MRI protocol using a few b-values might be relevant in a clinical setting for the estimation of non-Gaussian diffusion MRI parameters in normal breast tissue and breast lesions.

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound.

Science.gov (United States)

Luciani, M L; Pediconi, F; Telesca, M; Vasselli, F; Casali, V; Miglio, E; Passariello, R; Catalano, C

2011-09-01

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI). Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up. Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered. Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI.

Science.gov (United States)

Lobbes, Marc B I; Lalji, Ulrich C; Nelemans, Patty J; Houben, Ivo; Smidt, Marjolein L; Heuts, Esther; de Vries, Bart; Wildberger, Joachim E; Beets-Tan, Regina G

2015-01-01

Background - Contrast-enhanced spectral mammography (CESM) is a promising new breast imaging modality that is superior to conventional mammography for breast cancer detection. We aimed to evaluate correlation and agreement of tumor size measurements using CESM. As additional analysis, we evaluated whether measurements using an additional breast MRI exam would yield more accurate results. Methods - Between January 1(st) 2013 and April 1(st) 2014, 87 consecutive breast cancer cases that underwent CESM were collected and data on maximum tumor size measurements were gathered. In 57 cases, tumor size measurements were also available for breast MRI. Histopathological results of the surgical specimen served as gold standard in all cases. Results - The Pearson's correlation coefficients (PCC) of CESM versus histopathology and breast MRI versus histopathology were all >0.9, p1 cm between the two imaging modalities and histopathological results, we did not observe any advantage of performing an additional breast MRI after CESM in any of the cases. Conclusion - Quality of tumor size measurement using CESM is good and matches the quality of these measurement assessed by breast MRI. Additional measurements using breast MRI did not improve the quality of tumor size measurements.

Significance of Additional Non-Mass Enhancement in Patients with Breast Cancer on Preoperative 3T Dynamic Contrast Enhanced MRI of the Breast

International Nuclear Information System (INIS)

Cho, Yun Hee; Cho, Kyu Ran; Park, Eun Kyung; Seo, Bo Kyoung; Woo, Ok Hee; Cho, Sung Bum; Bae, Jeoung Won

2016-01-01

In preoperative assessment of breast cancer, MRI has been shown to identify more additional breast lesions than are detectable using conventional imaging techniques. The characterization of additional lesions is more important than detection for optimal surgical treatment. Additional breast lesions can be included in focus, mass, and non-mass enhancement (NME) on MRI. According to the fifth edition of the breast imaging reporting and data system (BI-RADS®), which includes several changes in the NME descriptors, few studies to date have evaluated NME in preoperative assessment of breast cancer. We investigated the diagnostic accuracy of BI-RADS descriptors in predicting malignancy for additional NME lesions detected on preoperative 3T dynamic contrast enhanced MRI (DCE-MRI) in patients with newly diagnosed breast cancer. Between January 2008 and December 2012, 88 patients were enrolled in our study, all with NME lesions other than the index cancer on preoperative 3T DCE-MRI and all with accompanying histopathologic examination. The MRI findings were analyzed according to the BI-RADS MRI lexicon. We evaluated the size, distribution, internal enhancement pattern, and location of NME lesions relative to the index cancer (i.e., same quadrant, different quadrant, or contralateral breast). On histopathologic analysis of the 88 NME lesions, 73 (83%) were malignant and 15 (17%) were benign. Lesion size did not differ significantly between malignant and benign lesions (P = 0.410). Malignancy was more frequent in linear (P = 0.005) and segmental (P = 0.011) distributions, and benignancy was more frequent in focal (P = 0.004) and regional (P < 0.001) NME lesions. The highest positive predictive value (PPV) for malignancy occurred in segmental (96.8%), linear (95.1%), clustered ring (100%), and clumped (92.0%) enhancement. Asymmetry demonstrated a high positive predictive value of 85.9%. The frequency of malignancy was higher for NME lesions located in the same quadrant with

Role of MRI in differentiating benign from malignant breast lesions ...

African Journals Online (AJOL)

Mohamed Ahmed Youssef

2017-02-15

Feb 15, 2017 ... detecting breast lesions than either T1- or T2-weighted imaging, but it is better to be performed in con- junction with contrast ... of MRI in several aspects of breast cancer diagnosis and management.2 ..... Hayes DF.: Normal ...

Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer?

Energy Technology Data Exchange (ETDEWEB)

Uematsu, Takayoshi [Shizuoka Cancer Center Hospital, Breast Imaging and Breast Intervention Section, Shizuoka (Japan); Kasami, Masako [Shizuoka Cancer Center Hospital, Department of Pathology, Naga-izumi, Shizuoka (Japan); Watanabe, Junichiro [Shizuoka Cancer Center Hospital, Division of Medical Oncology, Naga-izumi, Shizuoka (Japan)

2011-11-15

The purpose of this study was to assess the influence of background enhancement on the detection and staging of breast cancer using MRI as an adjunct to mammography or ultrasound. One hundred forty-six bilateral breast MRI examinations were evaluated to assess the extent of a known primary tumour and to problem solve after mammography or ultrasound without adjusting for the phase in the patients' menstrual cycle. The background enhancement was classified into four categories by visual evaluation: minimal, mild, moderate and marked. In total, 131 histologically confirmed abnormal cases (104 malignant and 27 benign) and 15 normal cases were included in the analysis. There was no tumour size-related bias between the groups (p = 0.522). For the primary index tumour, the sensitivities of MRI with minimal/mild and moderate/marked background enhancement were 100% and 76% (p = 0.001), respectively. Thus, the degree of background enhancement did not affect the specificity. For evaluating tumour extent (n = 104), the accuracy of MRI with moderate/marked background enhancement (52%) was significantly lower than that with minimal/mild background enhancement (84%; p = 0.002). The degree of background enhancement affected the detection and staging of breast cancer using MRI. (orig.)

High field MRI of axillary lymph nodes and breast cancer

NARCIS (Netherlands)

Korteweg, M.A.

2011-01-01

In this thesis nodal characteristics have been assessed with high field Magnetic Resonance Imaging (MRI) using a clinical scanner in order to discriminate non-metastatic from metastatic nodes of breast cancer patients. The final goal is to non-invasively determine nodal and tumor stage of breast

Overview of the role of pre-operative breast MRI in the absence of evidence on patient outcomes.

Science.gov (United States)

Sardanelli, Francesco

2010-02-01

The role of pre-operative breast MRI is outlined on the basis of the existing evidence in favor of a superior capability in comparison with mammography and sonography to detect ipsilateral and contralateral malignant lesions and to evaluate the disease extent, including the extensive intraductal component associated with invasive cancers. Patients with a potential higher anticipated benefit from pre-operative MRI can be identified as those: with mammographically dense breasts; with a unilateral multifocal/multicentric cancer or a synchronous bilateral cancer already diagnosed at mammography and sonography; with a lobular invasive cancer; at high-risk for breast cancer; with a cancer which shows a discrepancy in size of >1 cm between mammography and sonography; or under consideration for partial breast irradiation. More limited evidence exists in favor of MRI for evaluating candidates for total skin sparing mastectomy or for patients with Paget's disease. Irrespective of whether the clinical team routinely uses preoperative MRI or not: women newly diagnosed with breast cancer should always be informed of the potential risks and benefits of pre-operative MRI; results of pre-operative MRI should be interpreted taking into account clinical breast examination, mammography, sonography and verified by percutaneous biopsy; MRI-only detected lesions require MR-guidance for needle biopsy and pre-surgical localization, and these should be available or potentially accessible if pre-operative MRI is to be implemented; total therapy delay due to pre-operative MRI (including MRI-induced work-up) should not exceed one month; changes in therapy planning resulting from pre-operative MRI should be decided by a multidisciplinary team. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Routine use of standard breast MRI compared to axillary ultrasound for differentiating between no, limited and advanced axillary nodal disease in newly diagnosed breast cancer patients

Energy Technology Data Exchange (ETDEWEB)

Nijnatten, T.J.A. van, E-mail: Thiemovn@gmail.com [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Center+, Maastricht (Netherlands); GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht (Netherlands); Ploumen, E.H. [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Center+, Maastricht (Netherlands); Schipper, RJ. [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Center+, Maastricht (Netherlands); GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Catharina Hospital, Eindhoven (Netherlands); Goorts, B. [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Center+, Maastricht (Netherlands); GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht (Netherlands); Andriessen, E.H. [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Center+, Maastricht (Netherlands); Vanwetswinkel, S.; Schavemaker, M. [Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht (Netherlands); Nelemans, P. [Department of Epidemiology, Maastricht University Medical Center+, Maastricht (Netherlands); Vries, B. de [Department of Pathology, Zuyderland Hospital, Heerlen (Netherlands); and others

2016-12-15

Objectives: To compare standard breast MRI to dedicated axillary ultrasound (with or without tissue sampling) for differentiating between no, limited and advanced axillary nodal disease in breast cancer patients. Methods: All patients who underwent breast MRI and dedicated axillary ultrasound between 2009 and 2014 were eligible. Exclusion criteria were recurrent disease, neoadjuvant systemic therapy and not receiving completion axillary lymph node dissection after positive sentinel lymph node biopsy (SLNB). Two radiologists independently reassessed all MRI exams. Axillary ultrasound findings were retrospectively collected. Probability of advanced axillary nodal disease (pN2-3) given clinically node negative (cN0) or limited (cN1) findings was calculated, with corresponding negative predictive value (NPV) to exclude pN2-3 and positive predictive value (PPV) to identify axillary nodal disease. Histopathology served as gold standard. Results: A total of 377 cases resulted in 81.4% no, 14.4% limited and 4.2% advanced axillary nodal disease at final histopathology. Probability of pN2-3 given cN0 for breast MRI and axillary ultrasound was 0.7–0.9% versus 1.5% and probability of pN2-3 given cN1 was 11.6–15.4% versus 29.0%. When cN1 on breast MRI was observed, PPV to identify positive axillary nodal disease was 50.7% and 59.0%. Conclusions: Evaluation of axillary nodal status on standard breast MRI is comparable to dedicated axillary ultrasound in breast cancer patients. In patients who underwent preoperative standard breast MRI, axillary ultrasound is only required in case of suspicious nodal findings on MRI.

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

International Nuclear Information System (INIS)

Stivalet, Aude; Pigneur, Frederic; Luciani, Alain

2012-01-01

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

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Stivalet, Aude; Pigneur, Frederic (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France)); Luciani, Alain (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France); INSERM Unite U 955, Equipe 17, Univ. Paris Est Creteil, Creteil (France)), email: alain.luciani@hmn.aphp.fr (and others)

2012-05-15

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

MRI and pathological features of different molecular subtypes of breast cancers

International Nuclear Information System (INIS)

Yu Yang; Huo Tianlong; Lai Yunyao; Hong Nan

2014-01-01

Objective: To investigate the MRI and pathological features of different molecular subtypes of breast cancer. Methods: The data of 202 patients who underwent primary breast cancer resection were retrospectively reviewed. All of the patients had MRI preoperatively. The molecular subtypes of breast cancer defined by immunohistochemistry were classified as basal-like, luminal and HER-2 overexpression. Morphology (including mass or non-mass like enhancement, shape and margin of masses, unifocal or multifocal masses) and enhancement characteristics on MRI, histologic types and grades of tumors were analyzed with Chi-square test, exact test, Fisher exact test, Kruskal-Wallis H test, and Wilcoxon test. Results: Among the 202 patients, 34 were basal-like, 144 were luminal and 24 were HER-2 overexpression. The number of mass cases in each subtype was 29, 133 and 19 respectively,making no significant difference (χ 2 =4.136, P=0.126). As for the shape of basal-like lesions,8 were round,19 were lobular and 2 were irregular, while this distribution was 23, 58, 52 in luminal subtype and 1, 11, 7 in HER-2 overexpression subtype (χ 2 =13.391, P<0.05). The margin was also strikingly different among three groups (smooth, spiculate, irregular): 20, 5, 4 respectively in basal-like, 27, 53, 53 respectively in luminal, and 4, 7, 8 respectively in HER-2 overexpression (χ 2 =28.515, P<0.01). 52.6% (10/19) of HER-2 overexpression cases were multifocal, while only 6.9% (2/29) of luminal and 8.0% (24/133) of basal-like ones were multifocal (χ 2 =16.140, P<0.01). Characteristics in dynamic contrast-enhanced MRI were statistically different, with homogeneous, heterogeneous, and rim enhancement 0, 13, 16 respectively in basal-like cases, 28, 93, 11 respectively in luminal cases and 2, 11, 6 respectively in HER-2 overexpression cases (P<0.01). However, the difference for enhancement curve did not reach significance (P =0.457). Histologic types were significantly different among molecular

Contrast-enhanced color Doppler ultrasound characteristics in hypervascular breast tumors: comparison with MRI

International Nuclear Information System (INIS)

Alamo, L.; Fischer, U.

2001-01-01

The aim of this study was to evaluate the accuracy of contrast-enhanced color Doppler ultrasound (CE-US) in comparison with contrast-enhanced MR imaging (CE-MRI) in the discrimination of hypervascularized breast tumors. An additional CE-US of the breast was preoperatively performed in 40 patients with a hypervascular breast lesion detected on CE-MRI. The presence of blood flow signals and the morphological characteristics of the vessels in the breast lesions were evaluated pre- and post-contrast administration, as well as the dynamic aspects of the Doppler signal, including time interval to maximum signal enhancement and persistence of the signal enhancement. Twenty-three carcinomas and 17 fibroadenomas were explored. Considering initial signal enhancement > 100 % after the administration of contrast material as a criterion suggesting malignancy, CE-MRI showed a sensitivity of 100 % and a specificity of 76.5 % in the detection of malignant breast tumors. Color Doppler signals were consistently demonstrated in all carcinomas and in 68.7 % of fibroadenomas after the administration of Levovist, with CE-US showing a sensitivity of 95.6 % and a specificity of 5.9 %. Neither the mean number of vessels per tumor, nor the location of vessels, the time to maximum increase of the Doppler signal or the persistence of signal enhancement showed significant differences between benign and malignant lesions. Additional CE-US does not increase the low specificity of MRI in patients with hypervascularized breast tumors. (orig.)

Role of MRI in differentiating benign from malignant breast lesions ...

African Journals Online (AJOL)

Mohamed Ahmed Youssef

2017-02-15

Feb 15, 2017 ... renal dysfunction or previous reactions to contrast agents and will relieve the cost of examination.4,5. The aim of the study was to evaluate the role of the magnetic resonance imaging in differentiation of benign from malignant breast lesions using dynamic contrast enhanced MRI (DCE-MRI) and diffusion ...

Extra-mammary findings in breast MRI

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Rinaldi, Pierluigi; Costantini, M.; Belli, P.; Giuliani, M.; Bufi, E.; Fubelli, R.; Distefano, D.; Romani, M.; Bonomo, L. [Catholic University - Policlinic A. Gemelli, Department of Bio-Imaging and Radiological Sciences, Rome (Italy)

2011-11-15

Incidental extra-mammary findings in breast Magnetic Resonance Imaging (MRI) may be benign in nature, but may also represent a metastasis or another important lesion. We aimed to analyse the prevalence and clinical relevance of these unexpected findings. A retrospective review of 1535 breast MRIs was conducted. Only axial sequences were reassessed. Confirmation examinations were obtained in all cases. 285 patients had a confirmed incidental finding, which were located in the liver (51.9%), lung (11.2%), bone (7%), mediastinal lymph nodes (4.2%) or consisted of pleural/pericardial effusion (15.4%). 20.4% of incidental findings were confirmed to be malignant. Positive predictive value for MRI to detect a metastatic lesion was high if located within the bone (89%), lymph nodes (83%) and lung (59%), while it was low if located within the liver (9%) or if it consisted of pleural/pericardial effusion (6%). The axial enhanced sequence showed superior sensitivity to unenhanced images in detecting metastatic lesions, especially if only smaller ({<=}10 mm.) lesions were considered. The prevalence of metastatic incidental extra-mammary findings is not negligible. Particular attention should be to incidental findings located within the lung, bone and mediastinal lymph nodes. (orig.)

Dose Tc-99m MIBI scintimammography provide more information additive to contrast enhanced MRI in highly suspected breast cancer patients?

International Nuclear Information System (INIS)

Kim, Seong Jang; Kim, In Ju; Kim, Yong Ki; Bae, Young Tae

2000-01-01

The aim of this study was to investigate whether Tc-99m MIBI scintimammography (SMM) provide more information than contrast enhanced MRI in highly suspected breast cancer patients. This study included 32 breast lesions of 29 highly suspected patients having breast cancer. All patients were performed SMM and contrast enhanced MRI. The SMMs and contrast enhanced MRI were correlated with histopathologic results. Thirty breast lesions were diagnosed malignant diseases and 2 were diagnosed benign diseases. SMM showed 29 true positives (TP), 1 true negative (TN), 1 false positive (FP), and 1 false negative (FN). The sensitivity was 96.6%. Contrast enhanced MRI revealed 24 TP, 0 TN, 1 FP, 3 FN and 4 indeterminate cases. The sensitivity was 88.8%. In the assessment of axillary lymph node metastasis, SMM showed 9 TP, 10 TN, 0 FP, and 3 FN. The sensitivity and specificity were 75% and 100%. Contrast enhanced MRI revealed 6 TP, 9 TN, 1 FP, and 6 FN. The sensitivity and specificity were 50% and 90%. Among 4 indeterminate cases with MRI findings, SMM correctly diagnosed malignant breast diseases in 3 lesions. However, SMM showed false positive in 1 lesion. SMM could correctly diagnosed malignant breast diseases more 5 lesions than contrast enhanced MRI. SMM revealed higher sensitivity in detection of primary breast cancer and axillary LN metastasis than contrast enhanced MRI. SMMs could correctly diagnosed malignant breast diseases even if the MRI showed indeterminate findings. In highly suspected patients having breast cancer, SMM may provide additive information in detection of breast cancer if contrast enhanced MRI showed indeterminate findings but this is to be determined later by large population based study

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

International Nuclear Information System (INIS)

Probst, Heidi; Bragg, Christopher; Dodwell, David; Green, David; Hart, John

2014-01-01

Greater use of 3D conformal, Intensity Modulated Radiotherapy (IMRT) and external beam partial breast irradiation following local excision (LE) for breast cancer has necessitated a review of the effectiveness of immobilisation methods to stabilise breast tissue. To identify the suitability of currently available breast (rather than thorax) immobilisation techniques an appraisal of the literature was undertaken. The aim was to identify and evaluate the benefit of additional or novel immobilisation approaches (beyond the standard supine, single arm abducted and angled breast board technique adopted in most radiotherapy departments). A database search was supplemented with an individual search of key radiotherapy peer-reviewed journals, author searching, and searching of the grey literature. A total of 27 articles met the inclusion criteria. The review identified good reproducibility of the thorax using the standard supine arm-pole technique. Reproducibility with the prone technique appears inferior to supine methods (based on data from existing randomised controlled trials). Assessing the effectiveness of additional breast support devices (such as rings or thermoplastic material) is hampered by small sample sizes and a lack of randomised data for comparison. Attention to breast immobilisation is recommended, as well as agreement on how breast stability should be measured using volumetric imaging

Breast fat volume measurement using wide-bore 3 T MRI: comparison of traditional mammographic density evaluation with MRI density measurements using automatic segmentation.

Science.gov (United States)

Petridou, E; Kibiro, M; Gladwell, C; Malcolm, P; Toms, A; Juette, A; Borga, M; Dahlqvist Leinhard, O; Romu, T; Kasmai, B; Denton, E

2017-07-01

To compare magnetic resonance imaging (MRI)-derived breast density measurements using automatic segmentation algorithms with radiologist estimations using the Breast Imaging Reporting and Data Systems (BI-RADS) density classification. Forty women undergoing mammography and dynamic breast MRI as part of their clinical management were recruited. Fat-water separated MRI images derived from a two-point Dixon technique, phase-sensitive reconstruction, and atlas-based segmentation were obtained before and after intravenous contrast medium administration. Breast density was assessed using software from Advanced MR Analytics (AMRA), Linköping, Sweden, with results compared to the widely used four-quartile quantitative BI-RADS scale. The proportion of glandular tissue in the breast on MRI was derived from the AMRA sequence. The mean unenhanced breast density was 0.31±0.22 (mean±SD; left) and 0.29±0.21 (right). Mean breast density on post-contrast images was 0.32±0.19 (left) and 0.32±0.2 (right). There was "almost perfect" correlation between pre- and post-contrast breast density quantification: Spearman's correlation rho=0.98 (95% confidence intervals [CI]: 0.97-0.99; left) and rho=0.99 (95% CI: 0.98-0.99; right). The 95% limits of agreement were -0.11-0.08 (left) and -0.08-0.03 (right). Interobserver reliability for BI-RADS was "substantial": weighted Kappa k=0.8 (95% CI: 0.74-0.87). The Spearman correlation coefficient between BI-RADS and MRI breast density was rho=0.73 (95% CI: 0.60-0.82; left) and rho=0.75 (95% CI: 0.63-0.83; right) which was also "substantial". The AMRA sequence provides a fully automated, reproducible, objective assessment of fibroglandular breast tissue proportion that correlates well with mammographic assessment of breast density with the added advantage of avoidance of ionising radiation. Copyright © 2017 The Royal College of Radiologists. All rights reserved.

MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications

International Nuclear Information System (INIS)

Rella, L.; Telegrafo, M.; Nardone, A.; Milella, A.; Ianora, A.A. Stabile; Lioce, M.; Angelelli, G.; Moschetta, M.

2015-01-01

Aim: To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. Materials and methods: One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Results: Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). Conclusion: RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. -- Highlights: •RT could increase complication rates of implant-based breast reconstruction (IBR). •No general consensus

Dynamic MRI study for breast tumors

International Nuclear Information System (INIS)

Seki, Tsuneaki

1990-01-01

Application of MRI for diagnosis of breast tumors was retrospectively examined in 103 consecutive cases. Contrast enhancement, mostly by dynamic study, was performed in 83 cases using Gd-DTPA and 0.5 T superconductive apparatus. Results were compared to those of mammography and sonography. On dynamic study, carcinoma showed abrupt rise of signal intensity with clear-cut peak formation in early phase, while benign fibroadenoma showed slow rise of signal intensity and prolonged enhancement without peak formation. In 12 of 33 carcinomas (33%), peripheral ring enhancement was noted reflecting vascular stroma of histologic sections. All fibroadenomas showed homogenous enhancement without peripheral ring. In MRI, sensitivity, specificity, and accuracy were 86%, 96%, 91%. In mammography 82%, 95%, 87% and in ultrasonography 91%, 95%, 93%. Although MRI should not be regarded as routine diagnostic procedure because of expense and limited availability, it may afford useful additional information when standard mammographic findings are not conclusive. (author)

Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI

International Nuclear Information System (INIS)

King, Valencia; Gu, Yajia; Kaplan, Jennifer B.; Morris, Elizabeth A.; Brooks, Jennifer D.; Pike, Malcolm C.

2012-01-01

To evaluate the effect of menopausal status on the background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on breast MRI. Retrospective review identified 1,130 women who underwent screening breast MRI between July and November 2010. In 28 of these women, breast MRI was performed both at one time point while pre- and one time point while post-menopausal (median interval 49 months). Two independent readers blinded to menopausal status used categorical scales to rate BPE (minimal/mild/moderate/marked) and FGT (fatty/scattered/heterogeneously dense/dense). Consensus was reached when there was disagreement. The sign test was used to assess changes in rating categories, and the Spearman rank and Fisher's exact tests were used to measure correlations and associations between variables. Significant proportions of women demonstrated decreases in BPE and FGT on post-menopausal breast MRI (P = 0.0001 and P = 0.0009). BPE category was unchanged in 39 % (11/28) and decreased in 61 % (17/28) of women. FGT category was unchanged in 61 % (17/28) and decreased in 39 % (11/28) of women. Age, reason for menopause, or interval between MRIs had no significant impact on changes in BPE and FGT. On MRI, BPE, and FGT decrease after menopause in significant proportions of women; BPE decreases more than FGT. (orig.)

The correlation of background parenchymal enhancement in the contralateral breast with patient and tumor characteristics of MRI-screen detected breast cancers.

Science.gov (United States)

Vreemann, Suzan; Gubern-Mérida, Albert; Borelli, Cristina; Bult, Peter; Karssemeijer, Nico; Mann, Ritse M

2018-01-01

Higher background parenchymal enhancement (BPE) could be used for stratification of MRI screening programs since it might be related to a higher breast cancer risk. Therefore, the purpose of this study is to correlate BPE to patient and tumor characteristics in women with unilateral MRI-screen detected breast cancer who participated in an intermediate and high risk screening program. As BPE in the affected breast may be difficult to discern from enhancing cancer, we assumed that BPE in the contralateral breast is a representative measure for BPE in women with unilateral breast cancer. This retrospective study was approved by our local institutional board and a waiver for consent was granted. MR-examinations of women with unilateral breast cancers screen-detected on breast MRI were evaluated by two readers. BPE in the contralateral breast was rated according to BI-RADS. Univariate analyses were performed to study associations. Observer variability was computed. Analysis included 77 breast cancers in 76 patients (age: 48±9.8 years), including 62 invasive and 15 pure ductal carcinoma in-situ cases. A negative association between BPE and tumor grade (p≤0.016) and a positive association with progesterone status (p≤0.021) was found. The correlation was stronger when only considering invasive disease. Inter-reader agreement was substantial. Lower BPE in the contralateral breast in women with unilateral breast cancer might be associated to higher tumor grade and progesterone receptor negativity. Great care should be taken using BPE for stratification of patients to tailored screening programs.

Navicular bone position determined by positional MRI: a reproducibility study

Energy Technology Data Exchange (ETDEWEB)

Hansen, Philip; Nybing, Janus D. [Copenhagen University Hospital Frederiksberg and Bispebjerg, Department of Radiology, Frederiksberg (Denmark); Johannsen, Finn E.; Stallknecht, Sandra E. [Copenhagen University Hospital Bispebjerg, Institute of Sports Medicine Copenhagen, Copenhagen, NV (Denmark); Hangaard, Stine; Hansen, Bjarke B. [Copenhagen University Hospital Frederiksberg, Parker Institute, Department of Rheumatology, Frederiksberg (Denmark); Boesen, Mikael [Copenhagen University Hospital Frederiksberg and Bispebjerg, Department of Radiology, Frederiksberg (Denmark); Copenhagen University Hospital Frederiksberg, Parker Institute, Department of Rheumatology, Frederiksberg (Denmark)

2016-02-15

To examine intraobserver, interobserver and between-day reproducibility of positional MRI for evaluation of navicular bone height (NVH) and medial navicular position (MNP). Positional MRI (pMRI) of the foot was performed on ten healthy participants (0.25 T G-scanner). Scanning was performed in supine and standing position, respectively. Two radiologists evaluated the images in a blinded manner. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC) and 95 % limits of agreement as a percentage of the mean (LOA%). Intraobserver and interobserver reliability was ''substantial'' in both supine and standing position (ICC 0.86-0.98) and showed good agreement (LOA% 4.9-14.7 %). Between-day reliability of navicular height and medial navicular position in standing position remained substantial (ICC 0.85-0.92) with adequate agreement (LOA% 8.3-19.8 %). In supine position between-day reliability was ''moderate'' for NVH (ICC 0.72) and ''slight'' for MNP (ICC 0.39). Agreement remained adequate between-days for MNP in supine position (LOA% 17.7 %), but it was less than adequate for NVH in supine position (LOA% 24.2 %). Navicular height and medial navicular position can be measured by pMRI in a very reproducible manner within and between observers. Increased measurement variation is observed between-days in supine position, which may be due to small positional differences or other unknown biomechanical factors. (orig.)

Navicular bone position determined by positional MRI: a reproducibility study

International Nuclear Information System (INIS)

Hansen, Philip; Nybing, Janus D.; Johannsen, Finn E.; Stallknecht, Sandra E.; Hangaard, Stine; Hansen, Bjarke B.; Boesen, Mikael

2016-01-01

To examine intraobserver, interobserver and between-day reproducibility of positional MRI for evaluation of navicular bone height (NVH) and medial navicular position (MNP). Positional MRI (pMRI) of the foot was performed on ten healthy participants (0.25 T G-scanner). Scanning was performed in supine and standing position, respectively. Two radiologists evaluated the images in a blinded manner. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC) and 95 % limits of agreement as a percentage of the mean (LOA%). Intraobserver and interobserver reliability was ''substantial'' in both supine and standing position (ICC 0.86-0.98) and showed good agreement (LOA% 4.9-14.7 %). Between-day reliability of navicular height and medial navicular position in standing position remained substantial (ICC 0.85-0.92) with adequate agreement (LOA% 8.3-19.8 %). In supine position between-day reliability was ''moderate'' for NVH (ICC 0.72) and ''slight'' for MNP (ICC 0.39). Agreement remained adequate between-days for MNP in supine position (LOA% 17.7 %), but it was less than adequate for NVH in supine position (LOA% 24.2 %). Navicular height and medial navicular position can be measured by pMRI in a very reproducible manner within and between observers. Increased measurement variation is observed between-days in supine position, which may be due to small positional differences or other unknown biomechanical factors. (orig.)

Arterial spin labelling perfusion MRI of breast cancer using FAIR TrueFISP: Initial results

International Nuclear Information System (INIS)

Buchbender, S.; Obenauer, S.; Mohrmann, S.; Martirosian, P.; Buchbender, C.; Miese, F.R.; Wittsack, H.J.; Miekley, M.; Antoch, G.; Lanzman, R.S.

2013-01-01

Aim: To assess the feasibility of an unenhanced, flow-sensitive, alternating inversion recovery-balanced steady-state free precession (FAIR TrueFISP) arterial spin labelling (ASL) magnetic resonance imaging (MRI) technique for quantification of breast cancer perfusion. Materials and methods: Eighteen untreated breast tumour patients (mean age 53 ± 17 years, range 30–68 years) and four healthy controls (mean age 51 ± 14 years, range 33–68 years) were enrolled in this study and were imaged using a clinical 1.5 T MRI machine. Perfusion measurements were performed using a coronal single-section ASL FAIR TrueFISP technique in addition to a routine breast MRI examination. T1 relaxation time of normal breast parenchyma was determined in four healthy volunteers using the variable flip angle approach. The definitive diagnosis was obtained at histology after biopsy or surgery and was available for all patients. Results: ASL perfusion was successfully acquired in 13 of 18 tumour patients and in all healthy controls. The mean ASL perfusion of invasive ductal carcinoma tissue was significantly higher (88.2 ± 39.5 ml/100 g/min) compared to ASL perfusion of normal breast parenchyma (24.9 ± 12.7 ml/100 g/min; p < 0.05) and invasive lobular carcinoma (30.5 ± 4.3 ml/100 g/min; p < 0.05). No significant difference was found between the mean ASL perfusion of normal breast parenchyma and invasive lobular carcinoma tissue (p = 0.97). Conclusion: ASL MRI enables quantification of breast cancer perfusion without the use of contrast material. However, its impact on diagnosis and therapy management of breast tumours has to be evaluated in larger patient studies

Visualization of suspicious lesions in breast MRI based on intelligent neural systems

Science.gov (United States)

Twellmann, Thorsten; Lange, Oliver; Nattkemper, Tim Wilhelm; Meyer-Bäse, Anke

2006-05-01

Intelligent medical systems based on supervised and unsupervised artificial neural networks are applied to the automatic visualization and classification of suspicious lesions in breast MRI. These systems represent an important component of future sophisticated computer-aided diagnosis systems and enable the extraction of spatial and temporal features of dynamic MRI data stemming from patients with confirmed lesion diagnosis. By taking into account the heterogenity of the cancerous tissue, these techniques reveal the malignant, benign and normal kinetic signals and and provide a regional subclassification of pathological breast tissue. Intelligent medical systems are expected to have substantial implications in healthcare politics by contributing to the diagnosis of indeterminate breast lesions by non-invasive imaging.

MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy.

Science.gov (United States)

Li, Jie; Dershaw, D David; Lee, Carol H; Kaplan, Jennifer; Morris, Elizabeth A

2009-09-01

Follow-up MRI can be useful to confirm a benign diagnosis after MRI-guided breast biopsy. This retrospective study was undertaken to evaluate appropriate timing and imaging interpretation for the initial follow-up MRI when a benign, concordant histology is obtained using MRI-guided breast biopsy. Retrospective review was performed of 177 lesions visualized only by MRI in 172 women who underwent 9-gauge, vacuum-assisted core biopsy and marker placement with imaging-concordant benign histology. All underwent follow-up MRI within 12 months. Timing of the follow-up study, change in size, results of second biopsy if performed, and distance of localizing marker to the lesion on the follow-up study were recorded. At initial follow-up, 155 lesions were decreased or gone, 14 lesions were stable, and eight were enlarged. Seventeen (9.6%, 17/177) lesions underwent a second biopsy, including six enlarging, 10 stable, and one decreasing. Of these, four were malignant. Enlargement was seen in two carcinomas at 6 and 12 months. Two carcinomas, one stable at 2 months and another stable at 3 and 11 months, were rebiopsied because of suspicion of a missed lesion in the former and worrisome mammographic and sonographic changes in the latter. The distance of the marker from the lesion on follow-up did not correlate with biopsy accuracy. Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling.

Magnetic resonance imaging-guided navigation with a thermoplastic shell for breast-conserving surgery.

Science.gov (United States)

Abe, M; Kiryu, T; Sonoda, K; Kashiki, Y

2011-11-01

The aim of this study was to evaluate the accuracy of a magnetic resonance imaging (MRI) marking technique with a drape-type thermoplastic shell for planning breast-conserving surgery (BCS). A prospective review was performed on 35 consecutive patients who underwent MRI in the supine position and used the specified MRI marking technique. Eleven cases underwent pre-operative chemotherapy and 24 cases did not. After immobilizing the breast mound with a drape-type thermoplastic shell, patients underwent MRI, and the location of the lesion was marked on the shell. Resection lines were dyed blue by indigo carmine, which was pushed through the pores of the shell. Specimens obtained during BCS were sliced into 5-mm contiguous sections, and the margin was assessed for each specimen. Cancer foci less than 5 mm from the margin were classified as positive. Of 35 patients, 33 were included in the analysis; 2 were excluded due to a lack of effect of pre-operative chemotherapy. Of these 33 patients, 25 (75.8%) had negative margins and 7 (21.2%) had positive margins. Our MRI marking technique may be useful for evaluating the extent of tumors that were determined by MRI alone. Long-term outcomes of this technique should be evaluated further. Copyright © 2011 Elsevier Ltd. All rights reserved.

Analysing breast tissue composition with MRI using currently available short, simple sequences

International Nuclear Information System (INIS)

Chau, A.C.M.; Hua, J.; Taylor, D.B.

2016-01-01

Aim: To determine the most robust commonly available magnetic resonance imaging (MRI) sequence to quantify breast tissue composition at 1.5 T. Materials and methods: Two-dimensional (2D) T1-weighted, Dixon fat, Dixon water and SPAIR images were obtained from five participants and a breast phantom using a 1.5 T Siemens Aera MRI system. Manual segmentation of the breasts was performed, and an in-house computer program was used to generate signal intensity histograms. Relative trough depth and relative peak separation were used to determine the robustness of the images for quantifying the two breast tissues. Total breast volumes and percentage breast densities calculated using the four sequences were compared. Results: Dixon fat histograms had consistently low relative trough depth and relative peak separation compared to those obtained using other sequences. There was no significant difference in total breast volumes and percentage breast densities of the participants or breast phantom using Dixon fat and 2D T1-weighted histograms. Dixon water and SPAIR histograms were not suitable for quantifying breast tissue composition. Conclusion: Dixon fat images are the most robust for the quantification of breast tissue composition using a signal intensity histogram. - Highlights: • Signal intensity histogram analysis can determine robustness of images for quantification of breast tissue composition. • Dixon fat images are the most robust. • The characteristics of the signal intensity histograms from Dixon water and SPAIR images make quantification unsuitable.

Multiparametric and molecular imaging of breast tumors with MRI and PET/MRI; Multiparametrische und molekulare Bildgebung von Brusttumoren mit MRT und PET-MRT

Energy Technology Data Exchange (ETDEWEB)

Pinker, K. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria); Memorial Sloan-Kettering Cancer Center, Department of Radiology, Molecular Imaging and Therapy Service, New York (United States); State University of Florida, Department of Scientific Computing in Medicine, Florida (United States); Marino, M.A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria); Policlinico Universitario G. Martino, University of Messina, Department of Biomedical Sciences and Morphologic and Functional Imaging, Messina (Italy); Meyer-Baese, A. [State University of Florida, Department of Scientific Computing in Medicine, Florida (United States); Helbich, T.H. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Division fuer Molekulare und Gender Bildgebung, Wien (Austria)

2016-07-15

Magnetic resonance imaging (MRI) of the breast is an indispensable tool in breast imaging for many indications. Several functional parameters with MRI and positron emission tomography (PET) have been assessed for imaging of breast tumors and their combined application is defined as multiparametric imaging. Available data suggest that multiparametric imaging using different functional MRI and PET parameters can provide detailed information about the hallmarks of cancer and may provide additional specificity. Multiparametric and molecular imaging of the breast comprises established MRI parameters, such as dynamic contrast-enhanced MRI, diffusion-weighted imaging (DWI), MR proton spectroscopy ({sup 1}H-MRSI) as well as combinations of radiological and MRI techniques (e.g. PET/CT and PET/MRI) using radiotracers, such as fluorodeoxyglucose (FDG). Multiparametric and molecular imaging of the breast can be performed at different field-strengths (range 1.5-7 T). Emerging parameters comprise novel promising techniques, such as sodium imaging ({sup 23}Na MRI), phosphorus spectroscopy ({sup 31}P-MRSI), chemical exchange saturation transfer (CEST) imaging, blood oxygen level-dependent (BOLD) and hyperpolarized MRI as well as various specific radiotracers. Multiparametric and molecular imaging has multiple applications in breast imaging. Multiparametric and molecular imaging of the breast is an evolving field that will enable improved detection, characterization, staging and monitoring for personalized medicine in breast cancer. (orig.) [German] Die Magnetresonanztomographie (MRT) der Brust ist ein etabliertes nichtinvasives bildgebendes Verfahren mit vielfaeltigen Indikationen. In den letzten Jahren wurden zahlreiche funktionelle MRT- und Positronenemissionstomographie(PET)-Parameter in der Brustbildgebung evaluiert, und ihre kombinierte Anwendung ist als multiparametrische Bildgebung definiert. Bisherige Daten legen nahe, dass die multiparametrische Bildgebung mit MRT und PET

Correlation between MRI results and intraoperative findings in patients with silicone breast implants.

Science.gov (United States)

Lindenblatt, Nicole; El-Rabadi, Karem; Helbich, Thomas H; Czembirek, Heinrich; Deutinger, Maria; Benditte-Klepetko, Heike

2014-01-01

Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21-72) years, with a mean duration of implantation of 3.8 (range 1-28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

Fast MRI-guided vacuum-assisted breast biopsy: initial experience.

Science.gov (United States)

Liberman, Laura; Morris, Elizabeth A; Dershaw, D David; Thornton, Cynthia M; Van Zee, Kimberly J; Tan, Lee K

2003-11-01

The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. SUBJECTS AND METHODS. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Vacuum-assisted biopsy and surgical histology were correlated. Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4-6.4 cm). Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24-48 min). Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. One complication occurred: a hematoma that resolved with compression. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI.

Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI

Energy Technology Data Exchange (ETDEWEB)

King, Valencia [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Breast Imaging Section, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Gu, Yajia [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Kaplan, Jennifer B.; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Breast Imaging Section, New York, NY (United States); Brooks, Jennifer D.; Pike, Malcolm C. [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States)

2012-12-15

To evaluate the effect of menopausal status on the background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on breast MRI. Retrospective review identified 1,130 women who underwent screening breast MRI between July and November 2010. In 28 of these women, breast MRI was performed both at one time point while pre- and one time point while post-menopausal (median interval 49 months). Two independent readers blinded to menopausal status used categorical scales to rate BPE (minimal/mild/moderate/marked) and FGT (fatty/scattered/heterogeneously dense/dense). Consensus was reached when there was disagreement. The sign test was used to assess changes in rating categories, and the Spearman rank and Fisher's exact tests were used to measure correlations and associations between variables. Significant proportions of women demonstrated decreases in BPE and FGT on post-menopausal breast MRI (P = 0.0001 and P = 0.0009). BPE category was unchanged in 39 % (11/28) and decreased in 61 % (17/28) of women. FGT category was unchanged in 61 % (17/28) and decreased in 39 % (11/28) of women. Age, reason for menopause, or interval between MRIs had no significant impact on changes in BPE and FGT. On MRI, BPE, and FGT decrease after menopause in significant proportions of women; BPE decreases more than FGT. (orig.)

DCIS of the breast: the value of preoperative MRI

International Nuclear Information System (INIS)

Doyle, Anthony J.; Prakash, Sharath; Wang, Kaye; Cranshaw, Isaac; Taylor, Eletha; Oldfield, Robin

2016-01-01

Ductal carcinoma in situ (DCIS) of the breast is commonly treated surgically. The intent of this study was to evaluate whether preoperative MRI could add to mammography in predicting the extent of the disease. A series of patients with DCIS attending our surgical clinic for preoperative assessment were offered MRI as part of a prospective study. The extent of the disease indicated by mammography and MRI was compared with histopathology after definitive treatment. The null hypothesis was that MRI does not add to mammography in accurately predicting disease extent. Fifty patients make up the basis of this report. Mammography was concordant with the pathology in 31/50. MRI and mammography combined were concordant in 43/50. This is a statistically significant difference (P = 0.01, Fisher's exact test). Upstaging to mastectomy by MRI was correct in 7/8 patients, but downstaging was correct in only 2/4. The null hypothesis is rejected. MRI does add to mammography in accurately predicting the extent of DCIS. Upstaging by MRI is usually reliable.

Correlative study of the parameters of dynamic contrast-enhanced MRI and angiogenesis in breast lesions

International Nuclear Information System (INIS)

Tang Guangyu; Xiao Xiangsheng; Liu Yong; Yao Yiping; Li Wei; Zhao Wenrong; Li Peng

2007-01-01

Objective: To evaluate the relationship between dynamic contrast-enhanced MRI (DCE-MRI)-derived parameters and tumor angiogenesis in malignant and benign breast lesions. Methods: Fifty-one patients with malignant and benign breast lesions underwent DCE-MRI using a Philips Intera 1.5 T MR System and dedicated breast coil prospectively before operation. DCE-MRI derived parameters such as steepest slope (S max )), peak height (PH), time-to-peak (T peak ) were calculated based on time-signal intensity curve. The micro-vessel density (MVD) was counted and vascular endothelial growth factor (VEGF) expression was assessed in these patients after operation with immunohistochemical staining method. The parameters were correlated statistically with MVD counts and VEGF expression in breast cancer. The MVD counts and VEGF expression were also compared among the patients with breast cancer (29 cases), with fibroadenoma (12 cases), mastopathy (10 cases) and the normal tissue (10 cases). Results: The enhancement parameters S max (r=0.807, P peak (69 ± 38) correlated negatively with MVD counts (r=-0.425, P< 0.05). The mean value of MVD (65.09±15.81/200 times field) in patients with breast cancer were significantly higher than those with fibroadenoma, mastopathy or normal tissue (P=0.043, 0.018, 0.002 respectively). 69% (20/29 cases) of breast cancers demonstrated positive VEGF expression, which were significantly more than that of fibroadenoma, mastopathy or normal tissue (P=0.035, 0.007, 0.001 respectively). Moreover, the MVD counts (60.38±24.14) in the peripheral region of breast cancer were more than those in central region (37.64±16.52; t=2.635, P=0.016). There was a significant difference in MVD counts between breast cancers with metastasis to axillary lymph nodes (73.23±23.02) and those without metastasis (59.34±18.03), (t=2.303, P=0.031). Conclusions: Some parameters derived from DCE-MRI correlated positively with MVD counts and VEGF expression in patients with breast

Computer-aided detection in breast MRI : a systematic review and meta-analysis

NARCIS (Netherlands)

Dorrius, Monique D.; Jansen-van der Weide, Marijke C.; van Ooijen, Peter M. A.; Pijnappel, Ruud M.; Oudkerk, Matthijs

To evaluate the additional value of computer-aided detection (CAD) in breast MRI by assessing radiologists' accuracy in discriminating benign from malignant breast lesions. A literature search was performed with inclusion of relevant studies using a commercially available CAD system with automatic

Using deep learning to segment breast and fibroglandular tissue in MRI volumes

NARCIS (Netherlands)

Dalmis, M.U.; Litjens, G.J.; Holland, K.; Setio, A.A.A.; Mann, R.M.; Karssemeijer, N.; Gubern Merida, A.

2017-01-01

PURPOSE: Automated segmentation of breast and fibroglandular tissue (FGT) is required for various computer-aided applications of breast MRI. Traditional image analysis and computer vision techniques, such atlas, template matching, or, edge and surface detection, have been applied to solve this task.

Diagnostic imaging strategy for MDCT- or MRI-detected breast lesions: use of targeted sonography

International Nuclear Information System (INIS)

Nakano, Satoko; Ohtsuka, Masahiko; Mibu, Akemi; Karikomi, Masato; Sakata, Hitomi; Yamamoto, Masahiro

2012-01-01

Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice. We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups. Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up. Lesion size and shape were not significantly different among the benign, malignant and follow-up groups. Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions

Breast density as indicator for the use of mammography or MRI to screen women with familial risk for breast cancer (FaMRIsc: a multicentre randomized controlled trial

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Saadatmand Sepideh

2012-10-01

Full Text Available Abstract Background To reduce mortality, women with a family history of breast cancer often start mammography screening at a younger age than the general population. Breast density is high in over 50% of women younger than 50 years. With high breast density, breast cancer incidence increases, but sensitivity of mammography decreases. Therefore, mammography might not be the optimal method for breast cancer screening in young women. Adding MRI increases sensitivity, but also the risk of false-positive results. The limitation of all previous MRI screening studies is that they do not contain a comparison group; all participants received both MRI and mammography. Therefore, we cannot empirically assess in which stage tumours would have been detected by either test. The aim of the Familial MRI Screening Study (FaMRIsc is to compare the efficacy of MRI screening to mammography for women with a familial risk. Furthermore, we will assess the influence of breast density. Methods/Design This Dutch multicentre, randomized controlled trial, with balanced randomisation (1:1 has a parallel grouped design. Women with a cumulative lifetime risk for breast cancer due to their family history of ≥20%, aged 30–55 years are eligible. Identified BRCA1/2 mutation carriers or women with 50% risk of carrying a mutation are excluded. Group 1 receives yearly mammography and clinical breast examination (n = 1000, and group 2 yearly MRI and clinical breast examination, and mammography biennially (n = 1000. Primary endpoints are the number and stage of the detected breast cancers in each arm. Secondary endpoints are the number of false-positive results in both screening arms. Furthermore, sensitivity and positive predictive value of both screening strategies will be assessed. Cost-effectiveness of both strategies will be assessed. Analyses will also be performed with mammographic density as stratification factor. Discussion Personalized breast cancer screening

Values of kinetic features measured by computer-aided for breast MRI

International Nuclear Information System (INIS)

Zhang Lina; Zhao Zuowei; Song Qingwei; Wang Shaowu; Miao Yanwei

2012-01-01

Objective: To investigate the value of kinetic features measured by computer-aided diagnosis (CAD) for breast MRI. Methods: One hundred and sixty four lesions diagnosed pathologically by operation or biopsy comprised the analysis set. Automated lesion kinetic information from CADStream programs for breast MRI was identified. Three CAD variables were compared for benign and malignant lesions: initial phase peak enhancement (greatest percentage of signal intensity increase on first contrast enhanced sequence), delayed phase enhancement categorized by a single type of kinetics comprising the largest percentage of enhancement (washout, plateau, or persistent), and delayed phase enhancement categorized by single most suspicious type of kinetics (any washout > any plateau > any persistent). Morphological characteristics of breast lesions were described according to breast imaging and reporting data system (BI-RADS). Initial phase peak enhancement mean values between benign and malignant breast lesions were compared by using Wilcoxon rank-sum test, delayed phase enhancement categorized by a single type of kinetics comprising the largest percentage of enhancement or by single most suspicious type of kinetics between benign and malignant breast lesions were compared by using Chi-square test. Results: There were 72 benign and 92 malignant breast lesions. A total of 123 (75.0%) mass lesions were identified,and the other 41 (25.0%) lesions showed no mass. Thirty lesions were BI-RADS-MRI 2, 68 lesions were BI-RADS-MRI 3, 43 lesions were BI-RADS-MRI 4, 23 lesions were BI-RADS-MRI 5. Initial phase peak enhancement mean values of benign and malignant lesions were 237% (69% to 629%) and 336% (86% to 793%), respectively. There was no significant difference between benign and malignant lesions in initial peak enhancement mean value (Z=-1.626, P=0.104). Delayed phase enhancement categorized by single most suspicious type of kinetics (any washout > any plateau > any persistent) for

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

Science.gov (United States)

Fallenberg, E M; Dromain, C; Diekmann, F; Engelken, F; Krohn, M; Singh, J M; Ingold-Heppner, B; Winzer, K J; Bick, U; Renz, D M

2014-01-01

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. 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. 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. 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. • 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.

MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications.

Science.gov (United States)

Rella, L; Telegrafo, M; Nardone, A; Milella, A; Stabile Ianora, A A; Lioce, M; Angelelli, G; Moschetta, M

2015-09-01

To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Breast MRI at 3.0 T in a high-risk familial breast cancer screening cohort: comparison with 1.5 T screening studies.

Science.gov (United States)

Pickles, M D; Turnbull, L W

2012-07-01

The sensitivity of X-ray mammography for the detection of breast malignancy in younger females is lower than that of breast MRI; consequently, guidelines recommend annual MRI for patients with a significantly elevated lifetime risk. The improved signal-to-noise ratio obtainable at 3.0 T should result in data superior to those obtainable at 1.5 T. However, breast imaging on higher field strength systems poses specific problems. As a result, caution has been urged in the implementation of breast MRI at 3.0 T. The aim of this study was to determine if it is appropriate to use 3.0 T MRI in the screening of patients by comparing the summary statistics achieved by this 3.0 T MRI programme against the published results of 1.5 T screening studies. Over a 20-month period, 291 patients referred with an elevated familial risk of breast cancer were examined at 3.0 T. Resulting images were scored based on the Royal College of Radiologists Breast Group imaging classification. The reference standard was a combination of histology and follow-up imaging. Follow-up data were available in 267 patients. Analysis revealed positive and negative post-test probabilities of 28% [95% confidence intervals (CI); range, 10-60%] and 1% (95% CI; range, 0-2%), respectively. These results compared favourably against those of a recent meta-analysis [25.3% (95% CI; range, 18.4-33.8%) and 0.4% (95% CI; range, 0.2-0.9%), respectively]. Given the similar summary statistics between this work and the 1.5 T results, it would appear that screening of high-risk patients at 3.0 T has potential. Further studies should be undertaken to verify this result.

Textural kinetics: a novel dynamic contrast-enhanced (DCE)-MRI feature for breast lesion classification.

Science.gov (United States)

Agner, Shannon C; Soman, Salil; Libfeld, Edward; McDonald, Margie; Thomas, Kathleen; Englander, Sarah; Rosen, Mark A; Chin, Deanna; Nosher, John; Madabhushi, Anant

2011-06-01

Dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of the breast has emerged as an adjunct imaging tool to conventional X-ray mammography due to its high detection sensitivity. Despite the increasing use of breast DCE-MRI, specificity in distinguishing malignant from benign breast lesions is low, and interobserver variability in lesion classification is high. The novel contribution of this paper is in the definition of a new DCE-MRI descriptor that we call textural kinetics, which attempts to capture spatiotemporal changes in breast lesion texture in order to distinguish malignant from benign lesions. We qualitatively and quantitatively demonstrated on 41 breast DCE-MRI studies that textural kinetic features outperform signal intensity kinetics and lesion morphology features in distinguishing benign from malignant lesions. A probabilistic boosting tree (PBT) classifier in conjunction with textural kinetic descriptors yielded an accuracy of 90%, sensitivity of 95%, specificity of 82%, and an area under the curve (AUC) of 0.92. Graph embedding, used for qualitative visualization of a low-dimensional representation of the data, showed the best separation between benign and malignant lesions when using textural kinetic features. The PBT classifier results and trends were also corroborated via a support vector machine classifier which showed that textural kinetic features outperformed the morphological, static texture, and signal intensity kinetics descriptors. When textural kinetic attributes were combined with morphologic descriptors, the resulting PBT classifier yielded 89% accuracy, 99% sensitivity, 76% specificity, and an AUC of 0.91.

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

International Nuclear Information System (INIS)

Froeling, Vera; Diekmann, Felix; Renz, Diane M.; Fallenberg, Eva M.; Steffen, Ingo G.; Diekmann, Susanne; Schmitzberger, Florian F.; Lawaczeck, Ruediger

2013-01-01

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. 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. 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). 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. (orig.)

Template-based automatic breast segmentation on MRI by excluding the chest region

OpenAIRE

Lin, M; Chen, JH; Wang, X; Chan, S; Chen, S; Su, MY

2013-01-01

Purpose: Methods for quantification of breast density on MRI using semiautomatic approaches are commonly used. In this study, the authors report on a fully automatic chest template-based method. Methods: Nonfat-suppressed breast MR images from 31 healthy women were analyzed. Among them, one case was randomly selected and used as th e template, and the remaining 30 cases were used for testing. Unlike most model-based breast segmentation methods that use the breast region as the template, the c...

MRI and PET/CT of patients with bone metastases from breast carcinoma

International Nuclear Information System (INIS)

Grankvist, J.; Fisker, R.; Iyer, V.; Fründ, E.T.; Simonsen, C.; Christensen, T.; Stenbygaard, L.; Ewertz, M.; Larsson, E.-M.

2012-01-01

3.0 Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45–85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0 Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.

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

International Nuclear Information System (INIS)

Fallenberg, E.M.; Renz, D.M.; Dromain, C.; Diekmann, F.; Engelken, F.; Krohn, M.; Singh, J.M.; Bick, U.; Ingold-Heppner, B.; Winzer, K.J.

2014-01-01

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. 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. 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. 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. (orig.)

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

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Fallenberg, E.M.; Renz, D.M. [Charite - Universitaetsmedizin Berlin, Clinic of Radiology, Berlin (Germany); Dromain, C. [Institut Gustave Roussy, Department of Radiology, Villejuif cedex (France); Diekmann, F. [St. Joseph-Stift Bremen, Department of Medical Imaging, Bremen (Germany); Engelken, F.; Krohn, M.; Singh, J.M.; Bick, U. [Charite - Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Ingold-Heppner, B. [Charite - Universitaetsmedizin Berlin, Institute of Pathology, Berlin (Germany); Winzer, K.J. [Charite - Universitaetsmedizin Berlin, Breast Center, Department of Gynecology, Berlin (Germany)

2014-01-15

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. 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. 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. 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. (orig.)

Breast density quantification using magnetic resonance imaging (MRI) with bias field correction: a postmortem study.

Science.gov (United States)

Ding, Huanjun; Johnson, Travis; Lin, Muqing; Le, Huy Q; Ducote, Justin L; Su, Min-Ying; Molloi, Sabee

2013-12-01

Quantification of breast density based on three-dimensional breast MRI may provide useful information for the early detection of breast cancer. However, the field inhomogeneity can severely challenge the computerized image segmentation process. In this work, the effect of the bias field in breast density quantification has been investigated with a postmortem study. T1-weighted images of 20 pairs of postmortem breasts were acquired on a 1.5 T breast MRI scanner. Two computer-assisted algorithms were used to quantify the volumetric breast density. First, standard fuzzy c-means (FCM) clustering was used on raw images with the bias field present. Then, the coherent local intensity clustering (CLIC) method estimated and corrected the bias field during the iterative tissue segmentation process. Finally, FCM clustering was performed on the bias-field-corrected images produced by CLIC method. The left-right correlation for breasts in the same pair was studied for both segmentation algorithms to evaluate the precision of the tissue classification. Finally, the breast densities measured with the three methods were compared to the gold standard tissue compositions obtained from chemical analysis. The linear correlation coefficient, Pearson's r, was used to evaluate the two image segmentation algorithms and the effect of bias field. The CLIC method successfully corrected the intensity inhomogeneity induced by the bias field. In left-right comparisons, the CLIC method significantly improved the slope and the correlation coefficient of the linear fitting for the glandular volume estimation. The left-right breast density correlation was also increased from 0.93 to 0.98. When compared with the percent fibroglandular volume (%FGV) from chemical analysis, results after bias field correction from both the CLIC the FCM algorithms showed improved linear correlation. As a result, the Pearson's r increased from 0.86 to 0.92 with the bias field correction. The investigated CLIC method

Breast density quantification using magnetic resonance imaging (MRI) with bias field correction: A postmortem study

International Nuclear Information System (INIS)

Ding, Huanjun; Johnson, Travis; Lin, Muqing; Le, Huy Q.; Ducote, Justin L.; Su, Min-Ying; Molloi, Sabee

2013-01-01

Purpose: Quantification of breast density based on three-dimensional breast MRI may provide useful information for the early detection of breast cancer. However, the field inhomogeneity can severely challenge the computerized image segmentation process. In this work, the effect of the bias field in breast density quantification has been investigated with a postmortem study. Methods: T1-weighted images of 20 pairs of postmortem breasts were acquired on a 1.5 T breast MRI scanner. Two computer-assisted algorithms were used to quantify the volumetric breast density. First, standard fuzzy c-means (FCM) clustering was used on raw images with the bias field present. Then, the coherent local intensity clustering (CLIC) method estimated and corrected the bias field during the iterative tissue segmentation process. Finally, FCM clustering was performed on the bias-field-corrected images produced by CLIC method. The left–right correlation for breasts in the same pair was studied for both segmentation algorithms to evaluate the precision of the tissue classification. Finally, the breast densities measured with the three methods were compared to the gold standard tissue compositions obtained from chemical analysis. The linear correlation coefficient, Pearson'sr, was used to evaluate the two image segmentation algorithms and the effect of bias field. Results: The CLIC method successfully corrected the intensity inhomogeneity induced by the bias field. In left–right comparisons, the CLIC method significantly improved the slope and the correlation coefficient of the linear fitting for the glandular volume estimation. The left–right breast density correlation was also increased from 0.93 to 0.98. When compared with the percent fibroglandular volume (%FGV) from chemical analysis, results after bias field correction from both the CLIC the FCM algorithms showed improved linear correlation. As a result, the Pearson'sr increased from 0.86 to 0.92 with the bias field correction

Breast Dynamic Contrast Enhanced MRI: Fibrocystic Changes Presenting as a Non-mass Enhancement Mimicking Malignancy.

Science.gov (United States)

Milosevic, Zorica C; Nadrljanski, Mirjan M; Milovanovic, Zorka M; Gusic, Nina Z; Vucicevic, Slavko S; Radulovic, Olga S

2017-06-01

We aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination. Forty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography. The predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia. FCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.

Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-risk population?

International Nuclear Information System (INIS)

Arazi-Kleinman, T.; Causer, P.A.; Jong, R.A.; Hill, K.; Warner, E.

2009-01-01

Aim: To evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) computer-aided detection (CAD) for breast MRI screen-detected lesions recommended for biopsy in a high-risk population. Material and methods: Fifty-six consecutive Breast Imaging Reporting and Data System (BI-RADS) 3-5 lesions with histopathological correlation [nine invasive cancers, 13 ductal carcinoma in situ (DCIS) and 34 benign] were retrospectively evaluated using a breast MRI CAD prototype (CAD-Gaea). CAD evaluation was performed separately and in consensus by two radiologists specializing in breast imaging, blinded to the histopathology. Thresholds of 50, 80, and 100% and delayed enhancement were independently assessed with CAD. Lesions were rated as malignant or benign according to threshold and delayed enhancement only and in combination. Sensitivities, specificities, and negative predictive values (NPV) were determined for CAD assessments versus pathology. Initial MRI BI-RADS interpretation without CAD versus CAD assessments were compared using paired binary diagnostic tests. Results: Threshold levels for lesion enhancement were: 50% to include all malignant (and all benign) lesions; and 100% for all invasive cancer and high-grade DCIS. Combined use of threshold and enhancement patterns for CAD assessment was best (73% sensitivity, 56% specificity and 76% NPV for all cancer). Sensitivities and NPV were better for invasive cancer (100%/100%) than for all malignancies (54%/76%). Radiologists' MRI interpretation was more sensitive than CAD (p = 0.05), but less specific (p = 0.001) for cancer detection. Conclusion: The breast MRI CAD system used could not improve the radiologists' accuracy for distinguishing all malignant from benign lesions, due to the poor sensitivity for DCIS detection.

Comparative study of diffusion weighted imaging and dynamic contrast enhanced MRI for the detection of small breast cancers

International Nuclear Information System (INIS)

Tang Jianhua; Yan Fuhua; Zhou Meiling; Ye Fang; Xu Pengju

2008-01-01

Objective: To compare the sensitivity of diffusion weighted imaging (DWI) with dynamic contrast enhanced (DCE) MRI for the detection of small breast cancers and to evaluate the clinical value of DWI. Methods: Forty-eight patients with benign (n=25) and malignant (n=45) small breast lesions (≤2 cm) proved by pathology underwent DWI and DCE MRI. The DCE MRI was performed using FLASH sequence and the time-signal intensity curve was drawn. The DWI was performed using GRAPPA- EPI sequence with different b values (800, 1000 s/mm 2 ) and the ADC values of lesions were measured. The sensitivity and specificity of DWI for the detection of small breast cancers were compared with DCE MRI. Results: Forty of 45 small breast cancers and 19 of 25 small benign breast lesions were correctly diagnosed using DCE MRI. The sensitivity and positive predictive value of TIC were 88.9% (40/45) and 87.0% (40/46). With b values of 800 s/mm 2 and 1000 s/mm 2 , the average ADC values of small breast cancers were (1.153±0.192) x 10 -3 and (1.079±0.186) x 10 -3 mm 2 /s, while those of benign ones were (1.473±0.252) x 10 -3 and (1.419 ± 0.255) x 10 -3 mm 2 /s, respectively. There was no significant difference for the ADC values with different b values in the same group (P>0.05), while there was a significant difference between the malignant and the benign lesions (P 2 . Both the sensitivity and positive predictive value of diagnosis were 86.7% (39/45). The abilities of DWI and DCE MRI for the diagnosis of small breast cancers were the same. The sensitivity (93.3%) and positive predictive value (91.3%) were improved with the combination of DCE MRI and DWI. Conclusion: DWI has a high sensitivity for the detection of small breast cancers, the ADC value can provide valuable information in the differential diagnosis. (authors)

Feasibility of high temporal resolution breast DCE-MRI using compressed sensing theory.

Science.gov (United States)

Wang, Haoyu; Miao, Yanwei; Zhou, Kun; Yu, Yanming; Bao, Shanglian; He, Qiang; Dai, Yongming; Xuan, Stephanie Y; Tarabishy, Bisher; Ye, Yongquan; Hu, Jiani

2010-09-01

To investigate the feasibility of high temporal resolution breast DCE-MRI using compressed sensing theory. Two experiments were designed to investigate the feasibility of using reference image based compressed sensing (RICS) technique in DCE-MRI of the breast. The first experiment examined the capability of RICS to faithfully reconstruct uptake curves using undersampled data sets extracted from fully sampled clinical breast DCE-MRI data. An average approach and an approach using motion estimation and motion compensation (ME/MC) were implemented to obtain reference images and to evaluate their efficacy in reducing motion related effects. The second experiment, an in vitro phantom study, tested the feasibility of RICS for improving temporal resolution without degrading the spatial resolution. For the uptake-curve reconstruction experiment, there was a high correlation between uptake curves reconstructed from fully sampled data by Fourier transform and from undersampled data by RICS, indicating high similarity between them. The mean Pearson correlation coefficients for RICS with the ME/MC approach and RICS with the average approach were 0.977 +/- 0.023 and 0.953 +/- 0.031, respectively. The comparisons of final reconstruction results between RICS with the average approach and RICS with the ME/MC approach suggested that the latter was superior to the former in reducing motion related effects. For the in vitro experiment, compared to the fully sampled method, RICS improved the temporal resolution by an acceleration factor of 10 without degrading the spatial resolution. The preliminary study demonstrates the feasibility of RICS for faithfully reconstructing uptake curves and improving temporal resolution of breast DCE-MRI without degrading the spatial resolution.

High resolution MRI of the breast at 3 T: which BI-RADS registered descriptors are most strongly associated with the diagnosis of breast cancer?

International Nuclear Information System (INIS)

Pinker-Domenig, K.; Helbich, T.H.; Bogner, W.; Gruber, S.; Bickel, H.; Duffy, S.; Schernthaner, M.; Dubsky, P.; Pluschnig, U.; Rudas, M.; Trattnig, S.

2012-01-01

To identify which breast lesion descriptors in the ACR BI-RADS registered MRI lexicon are most strongly associated with the diagnosis of breast cancer when performing breast MR imaging at 3 T. 150 patients underwent breast MR imaging at 3 T. Lesion size, morphology and enhancement kinetics were assessed according to the BI-RADS registered classification. Sensitivity, specificity and diagnostic accuracy were assessed. The effects of the BI-RADS registered descriptors on sensitivity and specificity were evaluated. Data were analysed using logistic regression. Histopathological diagnoses were used as the standard of reference. The sensitivity, specificity and diagnostic accuracy of breast MRI at 3 T was 99%, 81% and 93%, respectively. In univariate analysis, the final diagnosis of malignancy was positively associated with irregular shape (p registered breast lesion descriptors that are mostly strongly associated with breast cancer in breast MR imaging at 3 T are lesion shape, lesion margin, internal enhancement pattern and Type 3 enhancement kinetics. (orig.)

Reproducible automated breast density measure with no ionizing radiation using fat-water decomposition MRI.

Science.gov (United States)

Ding, Jie; Stopeck, Alison T; Gao, Yi; Marron, Marilyn T; Wertheim, Betsy C; Altbach, Maria I; Galons, Jean-Philippe; Roe, Denise J; Wang, Fang; Maskarinec, Gertraud; Thomson, Cynthia A; Thompson, Patricia A; Huang, Chuan

2018-04-06

Increased breast density is a significant independent risk factor for breast cancer, and recent studies show that this risk is modifiable. Hence, breast density measures sensitive to small changes are desired. Utilizing fat-water decomposition MRI, we propose an automated, reproducible breast density measurement, which is nonionizing and directly comparable to mammographic density (MD). Retrospective study. The study included two sample sets of breast cancer patients enrolled in a clinical trial, for concordance analysis with MD (40 patients) and reproducibility analysis (10 patients). The majority of MRI scans (59 scans) were performed with a 1.5T GE Signa scanner using radial IDEAL-GRASE sequence, while the remaining (seven scans) were performed with a 3T Siemens Skyra using 3D Cartesian 6-echo GRE sequence with a similar fat-water separation technique. After automated breast segmentation, breast density was calculated using FraGW, a new measure developed to reliably reflect the amount of fibroglandular tissue and total water content in the entire breast. Based on its concordance with MD, FraGW was calibrated to MR-based breast density (MRD) to be comparable to MD. A previous breast density measurement, Fra80-the ratio of breast voxels with density changes and treatment response. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

Distinguishing benign and malignant breast tumors: preliminary comparison of kinetic modeling approaches using multi-institutional dynamic contrast-enhanced MRI data from the International Breast MR Consortium 6883 trial.

Science.gov (United States)

Sorace, Anna G; Partridge, Savannah C; Li, Xia; Virostko, Jack; Barnes, Stephanie L; Hippe, Daniel S; Huang, Wei; Yankeelov, Thomas E

2018-01-01

Comparative preliminary analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data collected in the International Breast MR Consortium 6883 multicenter trial was performed to distinguish benign and malignant breast tumors. Prebiopsy DCE-MRI data from 45 patients with suspicious breast lesions were obtained. Semiquantitative mean signal-enhancement ratio ([Formula: see text]) was calculated for all lesions, and quantitative pharmacokinetic, parameters [Formula: see text], [Formula: see text], and [Formula: see text], were calculated for the subset with available [Formula: see text] maps ([Formula: see text]). Diagnostic performance was estimated for DCE-MRI parameters and compared to standard clinical MRI assessment. Quantitative and semiquantitative metrics discriminated benign and malignant lesions, with receiver operating characteristic area under the curve (AUC) values of 0.71, 0.70, and 0.82 for [Formula: see text], [Formula: see text], and [Formula: see text], respectively ([Formula: see text]). At equal 94% sensitivity, the specificity and positive predictive value of [Formula: see text] (53% and 63%, respectively) and K trans (42% and 58%) were higher than clinical MRI assessment (32% and 54%). A multivariable model combining [Formula: see text] and clinical MRI assessment had an AUC value of 0.87. Quantitative pharmacokinetic and semiquantitative analyses of DCE-MRI improves discrimination of benign and malignant breast tumors, with our findings suggesting higher diagnostic accuracy using [Formula: see text]. [Formula: see text] has potential to help reduce unnecessary biopsies resulting from routine breast imaging.

Comparison of standard, prone and cine MRI in the evaluation of tethered cord

International Nuclear Information System (INIS)

Singh, Sukhjinder; Kline-Fath, Beth; Racadio, Judy M.; Bierbrauer, Karin; Salisbury, Shelia; Macaluso, Maurizio; Jackson, Elizabeth C.; Egelhoff, John C.

2012-01-01

Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement. We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging. Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented. Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69-77%, specificity 94%, positive predictive value 82-83%, negative predictive value 89-92%, correct diagnosis 88-90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging. Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use. (orig.)

Comparison of standard, prone and cine MRI in the evaluation of tethered cord

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Singh, Sukhjinder [Cohen Children' s Medical Center, Department of Radiology, New Hyde Park, NY (United States); Kline-Fath, Beth; Racadio, Judy M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Bierbrauer, Karin [Cincinnati Children' s Hospital Medical Center, Department of Neurosurgery, Cincinnati, OH (United States); Salisbury, Shelia; Macaluso, Maurizio [Cincinnati Children' s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH (United States); Jackson, Elizabeth C. [Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Division of Nephrology, Cincinnati, OH (United States); Egelhoff, John C. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

2012-06-15

Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement. We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging. Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented. Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69-77%, specificity 94%, positive predictive value 82-83%, negative predictive value 89-92%, correct diagnosis 88-90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging. Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use. (orig.)

Correlation between MRI results and intraoperative findings in patients with silicone breast implants

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Lindenblatt N

2014-07-01

Full Text Available Nicole Lindenblatt,1 Karem El-Rabadi,2 Thomas H Helbich,2 Heinrich Czembirek,3 Maria Deutinger,4 Heike Benditte-Klepetko5 1Division of Plastic and Hand Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland; 2Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna - General Hospital Vienna, 3Department of Radiology, Hospital Wiener Privatklinik, 4Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria; 5Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands Background: Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Methods: Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21–72 years, with a mean duration of implantation of 3.8 (range 1–28 years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Results: Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%. In seven of 17 removed implants (41%, the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Conclusion: Our results show that rupture of only the inner layers of the implant shell with integrity of

Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

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Rominger, M.; Frauenfelder, T. [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Berg, D. [Urbankrankenhaus Berlin, Anesthesiology, Berlin (Germany); Ramaswamy, A. [University Hospital Marburg, Pathology, Marburg (Germany); Timmesfeld, N. [Philipps University Marburg, Institute for Medical Biometry and Epidemiology, Marburg (Germany)

2016-05-15

To assess MRI-pathology concordance and factors influencing tumour size measurement in breast cancer. MRI tumour size (greatest diameter in anatomical planes (MRI-In-Plane) and greatest diameter along main tumour axis (MRI-MPR)) of 115 consecutive breast lesions (59 invasive lobular carcinoma, 46 invasive ductal carcinoma, and 10 ductal carcinoma in situ) was retrospectively compared to size measured at histopathology (pT size (Path-TNM) and greatest tumour diameter as relevant for excision (Path-Diameter; reference standard)). Histopathological tumour types, preoperative palpability, surgical management, additional high-risk lesions, and BI-RADS lesion type (mass versus non-mass enhancements) were assessed as possible influencing factors. Systematic errors were most pronounced between MRI-MPR and Path-TNM (7.1 mm, limits of agreement (LoA) [-21.7; 35.9]), and were lowest between MRI-In-Plane and Path-Diameter (0.2 mm, LoA [-19.7; 20.1]). Concordance rate of MRI-In-Plane with Path-Diameter was 86 % (97/113), overestimation 9 % (10/113) and underestimation 5 % (6/113); BI-RADS mass lesions were overestimated in 7 % (6/81) versus 41 % (13/32) for non-mass enhancements. On multivariate analysis only BI-RADS lesion type significantly influenced MRI-pathology concordance (p < 0.001). 2/59 (3 %) ILC did not enhance. Concordance rate varies according to the execution of MRI and histopathological measurements. Beyond this only non-mass enhancement significantly predicted discordance. (orig.)

Monitoring tumor response to neoadjuvant chemotherapy using MRI and 18F-FDG PET/CT in breast cancer subtypes

NARCIS (Netherlands)

Schmitz, Alexander M Th; Teixeira, Suzana C; Pengel, Kenneth E; Loo, Claudette E; Vogel, Wouter V; Wesseling, Jelle; Rutgers, Emiel J Th; Valdés Olmos, Renato A; Sonke, Gabe S; Rodenhuis, Sjoerd; Vrancken Peeters, Marie Jeanne T F D; Gilhuijs, Kenneth G A

2017-01-01

PURPOSE: To explore guidelines on the use of MRI and PET/CT monitoring primary tumor response to neoadjuvant chemotherapy (NAC), taking breast cancer subtype into account. MATERIALS AND METHODS: In this prospective cohort study, 188 women were included with stages II and III breast cancer. MRI and

MRI fused with prone FDG PET/CT improves the primary tumour staging of patients with breast cancer

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Garcia-Velloso, Maria J.; Ribelles, Maria J.; Rodriguez, Macarena; Sancho, Lidia; Prieto, Elena [Clinica Universidad de Navarra, Department of Nuclear Medicine, Pamplona (Spain); Fernandez-Montero, Alejandro [Clinica Universidad de Navarra, Department of Occupational Medicine, Pamplona (Spain); Santisteban, Marta [Clinica Universidad de Navarra, Department of Oncology, Pamplona (Spain); Rodriguez-Spiteri, Natalia; Martinez-Regueira, Fernando [Clinica Universidad de Navarra, Department of Surgery, Pamplona (Spain); Idoate, Miguel A. [Clinica Universidad de Navarra, Department of Pathology, Pamplona (Spain); Elizalde, Arlette; Pina, Luis J. [Clinica Universidad de Navarra, Department of Radiology, Pamplona (Spain)

2017-08-15

Our aim was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in primary tumour staging of patients with breast cancer. This retrospective study evaluated 45 women with 49 pathologically proven breast carcinomas. MRI and prone PET-CT scans with time-of-flight and point-spread-function reconstruction were performed with the same dedicated breast coil. The studies were assessed by a radiologist and a nuclear medicine physician, and evaluation of fused images was made by consensus. The final diagnosis was based on pathology (90 lesions) or follow-up ≥ 24 months (17 lesions). The study assessed 72 malignant and 35 benign lesions with a median size of 1.8 cm (range 0.3-8.4 cm): 31 focal, nine multifocal and nine multicentric cases. In lesion-by-lesion analysis, sensitivity, specificity, positive and negative predictive values were 97%, 80%, 91% and 93% for MRI, 96%, 71%, 87%, and 89% for prone PET, and 97%. 94%, 97% and 94% for MRI fused with PET. Areas under the curve (AUC) were 0.953, 0.850, and 0.983, respectively (p < 0.01). MRI fused with FDG-PET is more accurate than FDG-PET in primary tumour staging of breast cancer patients and increases the specificity of MRI. (orig.)

Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy

International Nuclear Information System (INIS)

Pengel, Kenneth E.; Loo, Claudette E.; Koolen, Bas B.; Vogel, Wouter V.; Valdes Olmos, Renato A.; Wesseling, Jelle; Lips, Esther H.; Rutgers, Emiel J.T.; Vrancken Peeters, Marie Jeanne T.F.D.; Rodenhuis, Sjoerd; Gilhuijs, Kenneth G.A.

2014-01-01

To explore the potential complementary value of PET/CT and dynamic contrast-enhanced MRI in predicting pathological response to neoadjuvant chemotherapy (NAC) of breast cancer and the dependency on breast cancer subtype. We performed 18 F-FDG PET/CT and MRI examinations before and during NAC. The imaging features evaluated on both examinations included baseline and changes in 18 F-FDG maximum standardized uptake value (SUVmax) on PET/CT, and tumour morphology and contrast uptake kinetics on MRI. The outcome measure was a (near) pathological complete response ((near-)pCR) after surgery. Receiver operating characteristic curves with area under the curve (AUC) were used to evaluate the relationships between patient, tumour and imaging characteristics and tumour responses. Of 93 patients, 43 achieved a (near-)pCR. The responses varied among the different breast cancer subtypes. On univariate analysis the following variables were significantly associated with (near-)pCR: age (p = 0.033), breast cancer subtype (p < 0.001), relative change in SUVmax on PET/CT (p < 0.001) and relative change in largest tumour diameter on MRI (p < 0.001). The AUC for the relative reduction in SUVmax on PET/CT was 0.78 (95 % CI 0.68-0.88), and for the relative reduction in tumour diameter at late enhancement on MRI was 0.79 (95 % CI 0.70-0.89). The AUC increased to 0.90 (95 % CI 0.83-0.96) in the final multivariate model with PET/CT, MRI and breast cancer subtype combined (p = 0.012). PET/CT and MRI showed comparable value for monitoring response during NAC. Combined use of PET/CT and MRI had complementary potential. Research with more patients is required to further elucidate the dependency on breast cancer subtype. (orig.)

MRI findings and correlation with pathological features in breast phyllodes tumor

International Nuclear Information System (INIS)

Shen Xigang; Tan Hongna; Peng Weijun; Li Ruimin; Gu Yajia; Huang Dan; Mao Jian; Zhou Liangping

2011-01-01

Objective: To study the MR Imaging features of breast phyllodes tumor (PT), and to correlate it with pathological results. Method: Clinical and MRI findings were retrospectively reviewed in twenty-seven women with 28 PTs lesions confirmed by surgical pathology. Statistical analyses were one-way ANOVA for size analysis, Fisher exact test for analysis of MR appearances and Spearman correlation to study the relationship between MRI findings and BI-RADS categories. Results: (1) The histologic findings were benign, borderline and malignant PTs in 14.3% (4/28), 53.6% (15/28) and 32.1% (9/28) of lesions, respectively. (2) The mean maximum-diameter were (6.4±3.9) cm, (5.7±2.2) cm in borderline type and (4.8±1.8) cm in benign type respectively. The results showed differences in lesion's size among the three type (F= 287.541, P=0.000), especially between malignant and benign type (P=0.033). (3) Internal non-enhanced septation and silt-like changes on enhanced images, as well as time-signal curve on MRI correlated significantly with the histological grade (P<0.05). (4) If the category BI-RADS ≥ 4a was considered to be a suspicious sign for malignant lesion, the diagnostic accuracy of MRI would be 96.4% (27/28), and the BI-RADS category of the MRI could reflect the PT's histological grade with a low correlation coefficient (r=0.382, P=0.045). Conclusion: The findings of PT on MRI have some characteristics, with tumor size and several MRI features correlating with the histological grade of breast PT. (authors)

Added Value of Breast MRI for Preoperative Diagnosis of Ductal Carcinoma In Situ: Diagnostic Performance on 362 Patients.

Science.gov (United States)

Petrillo, Antonella; Fusco, Roberta; Petrillo, Mario; Triunfo, Flavia; Filice, Salvatore; Vallone, Paolo; Setola, Sergio Venanzio; Rubulotta, Mariarosaria; Di Bonito, Maurizio; Rinaldo, Massimo; D'Aiuto, Massimiliano; Brunetti, Arturo

2017-06-01

The purpose of this study was to evaluate the added value of breast magnetic resonance imaging (MRI) in preoperative diagnosis of ductal carcinoma in situ (DCIS). We reviewed our institution database of 3499 consecutive patients treated for breast cancer. A total of 362 patients with histologically proven DCIS were selected from the institutional database. Of these, 245 (67.7%) preoperatively underwent conventional imaging (CI) (mammography/ultrasonography) (CI group), and 117 (32.3%) underwent CI and dynamic MRI (CI + MRI group). The pathology of surgical specimens served as a reference standard. The Mann-Whitney U, χ 2 test, and Spearman correlation coefficient were performed. The CI + MRI group showed a sensitivity of 98.5% with an increase of 10.1% compared with the CI group to detect pure DCIS. Dynamic MRI identified 19.7% (n = 13) additional pure DCIS compared with CI. In the CI + MRI group, a single (1.5%) false negative was reported, whereas in the CI group, 11 (11.6%) false negatives were reported. Moreover, the CI + MRI group showed a sensitivity of 98.0% to detect DCIS + small invasive component. In this group, dynamic MRI identified 21.6% (n = 11) additional DCIS and a single (2.0%) false negative compared with the CI group, whereas in the CI group, 7 (4.7%) false negatives were reported. MRI and histopathologically measured lesion sizes, Breast Imaging Reporting and Data System MRI assessment categories, and enhancement signal intensity curve types showed a significant correlation. The MRI detection rate of DCIS increased significantly with increasing nuclear grade. Preoperative breast MRI showed a better accuracy then CI in preoperative diagnosis for both pure DCIS and DCIS + small invasive component with a precise assessment of lesion size. This can provide a more appropriate management of DCIS patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Lesion type and reader experience affect the diagnostic accuracy of breast MRI: A multiple reader ROC study

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Baltzer, Pascal A.T., E-mail: patbaltzer@gmail.com [Department of Biomedical Imaging and Imge-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna (Austria); Kaiser, Werner Alois [Department of Diagnostic and Interventional Radiology, University Hospital Jena, Erlanger Allee 101, 07740 Jena (Germany); Dietzel, Matthias, E-mail: dietzelmatthias2@hotmail.com [Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen (Germany)

2015-01-15

Highlights: • The main findings of our study are, that reader experience and lesion type (i.e., mass versus non-mass enhancement) are independent predictors of the diagnostic accuracy of breast MRI. • Specifically, benign and malignant non-mass lesions cannot be differentiated with sufficient accuracy, especially if readers are not experienced. • We conclude that future research in breast MRI should focus on non-mass lesions, as these are the problem makers in modern breast MRI. - Abstract: Purpose: To evaluate the influence of lesion type (mass versus non-mass) and reader experience on the diagnostic performance of breast MRI (BMRI) in a non-screening setting. Materials and methods: Consecutive patients (mean age, 55 ± 12 years) with breast lesions that were verified by biopsy or surgery, and who had had BMRI as part of their diagnostic workup, were eligible for this retrospective single-center study. Cancers diagnosed by biopsy before BMRI were excluded to eliminate biological and interpretation bias due to biopsy or chemotherapy effects (n = 103). Six blinded readers (experience level, high (HE, n = 2); intermediate (IE, n = 2); and low (LE, n = 2)) evaluated all examinations and assigned independent MRI BI-RADS ratings. Lesion type (mass, non-mass, focal) was noted. Receiver operating characteristics (ROC) and logistic regression analysis was performed to compare diagnostic accuracies. Results: There were 259 histologically verified lesions (123 malignant, 136 benign) investigated. There were 169 mass (103 malignant, 66 benign) and 48 non-mass lesions (19 malignant, 29 benign). Another 42 lesions that met the inclusion criteria were biopsied due to conventional findings (i.e., microcalcifications, architectural distortions), but did not enhance on MRI (41 benign, one DCIS). ROC analysis revealed a total area under the curve (AUC) between 0.834 (LE) and 0.935 (HI). Logistic regression identified a significant effect of non-mass lesions (P < 0.0001) and

[MRI findings and pathological features of occult breast cancer].

Science.gov (United States)

Zhang, J J; Yang, X T; Du, X S; Zhang, J X; Hou, L N; Niu, J L

2018-01-23

Objective: To investigate the magnetic resonance imaging (MRI) findings and clinicopathological features of primary lesions in patients with occult breast cancer (OBC). Methods: The imaging reports from the Breast Imaging Reporting and Data System in 2013 were retrospectively analyzed to investigate the morphology and the time signal intensity curve (TIC) of breast lesions in patients with OBC. The clinical and pathological characteristics of these patients were also included. Results: A total of 34 patients were enrolled. Among these patients, 24 patients underwent modified radical mastectomy and 18 of them had primary breast carcinoma in pathological sections. MRI detected 17 cases of primary lesions, including six masse lesions with a diameter of 0.6-1.2 cm (average 0.9 cm), and 11 non-mass lesions with four linear distributions, three segmental distributions, three focal distributions, and one regions distribution. Five patients had TIC typeⅠprimary lesions, ten had TIC type Ⅱ primary lesions, and two had TIC type Ⅲ primary lesions. Among all 34 cases, 23 of them had complete results of immunohistochemistry: 11 estrogen receptor (ER) positive lesions (47.8%), tenprogesterone receptor (PR) positive lesions (43.5%), seven human epidermal growth factor receptor 2 (HER-2) positive lesions (30.4%), and 20high expression(>14%) of Ki-67 (87.0%). The proportion of type luminal A was 4.3%, type luminal B was 43.5%, triple negative breast cancer (TNBC) was 30.4%, and HER-2 over expression accounted for 21.7%. Conclusions: The primary lesions of OBC usually manifested as small mass lesions, or focal, linear or segmental distribution of non-mass lesions. The positive rate of ER and PR was low, but the positive rate of HER-2 and the proliferation index of Ki-67 was high. Type luminal B is the most common molecular subtype.

The role of a prone setup in breast radiation therapy.

Science.gov (United States)

Huppert, Nelly; Jozsef, Gabor; Dewyngaert, Keith; Formenti, Silvia Chiara

2011-01-01

Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

The role of a prone setup in breast radiation therapy

Directory of Open Access Journals (Sweden)

Nelly eHuppert

2011-10-01

Full Text Available Most patients undergoing breast conservation therapy (BCT receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy (IMRT and image-guided radiation therapy (IGRT have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

The Role of a Prone Setup in Breast Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Huppert, Nelly; Jozsef, Gabor; DeWyngaert, Keith; Formenti, Silvia Chiara, E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York University Langone Medical Center, New York, NY (United States)

2011-10-11

Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

Template-based automatic breast segmentation on MRI by excluding the chest region

International Nuclear Information System (INIS)

Lin, Muqing; Chen, Jeon-Hor; Wang, Xiaoyong; Su, Min-Ying; Chan, Siwa; Chen, Siping

2013-01-01

Purpose: Methods for quantification of breast density on MRI using semiautomatic approaches are commonly used. In this study, the authors report on a fully automatic chest template-based method. Methods: Nonfat-suppressed breast MR images from 31 healthy women were analyzed. Among them, one case was randomly selected and used as the template, and the remaining 30 cases were used for testing. Unlike most model-based breast segmentation methods that use the breast region as the template, the chest body region on a middle slice was used as the template. Within the chest template, three body landmarks (thoracic spine and bilateral boundary of the pectoral muscle) were identified for performing the initial V-shape cut to determine the posterior lateral boundary of the breast. The chest template was mapped to each subject's image space to obtain a subject-specific chest model for exclusion. On the remaining image, the chest wall muscle was identified and excluded to obtain clean breast segmentation. The chest and muscle boundaries determined on the middle slice were used as the reference for the segmentation of adjacent slices, and the process continued superiorly and inferiorly until all 3D slices were segmented. The segmentation results were evaluated by an experienced radiologist to mark voxels that were wrongly included or excluded for error analysis. Results: The breast volumes measured by the proposed algorithm were very close to the radiologist's corrected volumes, showing a % difference ranging from 0.01% to 3.04% in 30 tested subjects with a mean of 0.86% ± 0.72%. The total error was calculated by adding the inclusion and the exclusion errors (so they did not cancel each other out), which ranged from 0.05% to 6.75% with a mean of 3.05% ± 1.93%. The fibroglandular tissue segmented within the breast region determined by the algorithm and the radiologist were also very close, showing a % difference ranging from 0.02% to 2.52% with a mean of 1.03% ± 1.03%. The

Template-based automatic breast segmentation on MRI by excluding the chest region

Energy Technology Data Exchange (ETDEWEB)

Lin, Muqing [Tu and Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020 and National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, 518060 China (China); Chen, Jeon-Hor [Tu and Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020 and Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan (China); Wang, Xiaoyong; Su, Min-Ying, E-mail: msu@uci.edu [Tu and Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020 (United States); Chan, Siwa [Department of Radiology, Taichung Veterans General Hospital, Taichung 40407, Taiwan (China); Chen, Siping [National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, 518060 China (China)

2013-12-15

Purpose: Methods for quantification of breast density on MRI using semiautomatic approaches are commonly used. In this study, the authors report on a fully automatic chest template-based method. Methods: Nonfat-suppressed breast MR images from 31 healthy women were analyzed. Among them, one case was randomly selected and used as the template, and the remaining 30 cases were used for testing. Unlike most model-based breast segmentation methods that use the breast region as the template, the chest body region on a middle slice was used as the template. Within the chest template, three body landmarks (thoracic spine and bilateral boundary of the pectoral muscle) were identified for performing the initial V-shape cut to determine the posterior lateral boundary of the breast. The chest template was mapped to each subject's image space to obtain a subject-specific chest model for exclusion. On the remaining image, the chest wall muscle was identified and excluded to obtain clean breast segmentation. The chest and muscle boundaries determined on the middle slice were used as the reference for the segmentation of adjacent slices, and the process continued superiorly and inferiorly until all 3D slices were segmented. The segmentation results were evaluated by an experienced radiologist to mark voxels that were wrongly included or excluded for error analysis. Results: The breast volumes measured by the proposed algorithm were very close to the radiologist's corrected volumes, showing a % difference ranging from 0.01% to 3.04% in 30 tested subjects with a mean of 0.86% ± 0.72%. The total error was calculated by adding the inclusion and the exclusion errors (so they did not cancel each other out), which ranged from 0.05% to 6.75% with a mean of 3.05% ± 1.93%. The fibroglandular tissue segmented within the breast region determined by the algorithm and the radiologist were also very close, showing a % difference ranging from 0.02% to 2.52% with a mean of 1.03% ± 1

Monitoring tumor response to neoadjuvant chemotherapy using MRI and 18F-FDG PET/CT in breast cancer subtypes

NARCIS (Netherlands)

Schmitz, Alexander M. Th; Teixeira, Suzana C.; Pengel, Kenneth E.; Loo, Claudette E.; Vogel, Wouter V.; Wesseling, Jelle; Rutgers, Emiel J. Th; Valdés Olmos, Renato A.; Sonke, Gabe S.; Rodenhuis, Sjoerd; Vrancken Peeters, Marie Jeanne T. F. D.; Gilhuijs, Kenneth G. A.

2017-01-01

To explore guidelines on the use of MRI and PET/CT monitoring primary tumor response to neoadjuvant chemotherapy (NAC), taking breast cancer subtype into account. In this prospective cohort study, 188 women were included with stages II and III breast cancer. MRI and 18F-FDG-PET/CT were acquired

Hybrid 18F-FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

International Nuclear Information System (INIS)

Goorts, Briete; Nijnatten, Thiemo J.A. van; Voeoe, Stefan; Wildberger, Joachim E.; Lobbes, Marc B.I.; Kooreman, Loes F.S.; Boer, Maaike de; Keymeulen, Kristien B.M.I.; Aarnoutse, Romy; Smidt, Marjolein L.; Mottaghy, Felix M.

2017-01-01

Our purpose in this study was to assess the added clinical value of hybrid 18 F-FDG-PET/MRI compared to conventional imaging for locoregional staging in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). In this prospective study, primary invasive cT2-4 N0 or cT1-4 N+ breast cancer patients undergoing NAC were included. A PET/MRI breast protocol was performed before treatment. MR images were evaluated by a breast radiologist, blinded for PET images. PET images were evaluated by a nuclear physician. Afterwards, a combined PET/MRI report was written. PET/MRI staging was compared to conventional imaging, i.e., mammography, ultrasound and MRI. The proportion of patients with a modified treatment plan based on PET/MRI findings was analyzed. A total of 40 patients was included. PET/MRI was of added clinical value in 20.0% (8/40) of patients, changing the treatment plan in 10% and confirming the malignancy of suspicious lesions on MRI in another 10%. In seven (17.5%) patients radiotherapy fields were extended because of additional or affirmative PET/MRI findings being lymph node metastases (n = 5) and sternal bone metastases (n = 2). In one (2.5%) patient radiotherapy fields were reduced because of fewer lymph node metastases on PET/MRI compared to conventional imaging. Interestingly, all treatment changes were based on differences in number of lymph nodes suspicious for metastasis or number of distant metastasis, whereas differences in intramammary tumor extent were not observed. Prior to NAC, PET/MRI shows promising results for locoregional staging compared to conventional imaging, changing the treatment plan in 10% of patients and potentially replacing PET/CT or tissue sampling in another 10% of patients. (orig.)

MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies

Energy Technology Data Exchange (ETDEWEB)

Spick, Claudio; Pinker-Domenig, Katja; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), General Hospital Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

2014-06-15

To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53 ± 0.38 x 10{sup -3} mm{sup 2}/s in benign lesions and 1.06 ± 0.27 x 10{sup -3} mm{sup 2}/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58 x 10{sup -3} mm{sup 2}/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. (orig.)

Breast cancer molecular subtype classifier that incorporates MRI features.

Science.gov (United States)

Sutton, Elizabeth J; Dashevsky, Brittany Z; Oh, Jung Hun; Veeraraghavan, Harini; Apte, Aditya P; Thakur, Sunitha B; Morris, Elizabeth A; Deasy, Joseph O

2016-07-01

To use features extracted from magnetic resonance (MR) images and a machine-learning method to assist in differentiating breast cancer molecular subtypes. This retrospective Health Insurance Portability and Accountability Act (HIPAA)-compliant study received Institutional Review Board (IRB) approval. We identified 178 breast cancer patients between 2006-2011 with: 1) ERPR + (n = 95, 53.4%), ERPR-/HER2 + (n = 35, 19.6%), or triple negative (TN, n = 48, 27.0%) invasive ductal carcinoma (IDC), and 2) preoperative breast MRI at 1.5T or 3.0T. Shape, texture, and histogram-based features were extracted from each tumor contoured on pre- and three postcontrast MR images using in-house software. Clinical and pathologic features were also collected. Machine-learning-based (support vector machines) models were used to identify significant imaging features and to build models that predict IDC subtype. Leave-one-out cross-validation (LOOCV) was used to avoid model overfitting. Statistical significance was determined using the Kruskal-Wallis test. Each support vector machine fit in the LOOCV process generated a model with varying features. Eleven out of the top 20 ranked features were significantly different between IDC subtypes with P machine-learning-based predictive model using features extracted from MRI that can distinguish IDC subtypes with significant predictive power. J. Magn. Reson. Imaging 2016;44:122-129. © 2016 Wiley Periodicals, Inc.

In vitro assessment of MRI issues at 3-Tesla for a breast tissue expander with a remote port.

Science.gov (United States)

Linnemeyer, Hannah; Shellock, Frank G; Ahn, Christina Y

2014-04-01

A patient with a breast tissue expander may require a diagnostic assessment using magnetic resonance imaging (MRI). To ensure patient safety, this type of implant must undergo in vitro MRI testing using proper techniques. Therefore, this investigation evaluated MRI issues (i.e., magnetic field interactions, heating, and artifacts) at 3-Tesla for a breast tissue expander with a remote port. A breast tissue expander with a remote port (Integra Breast Tissue Expander, Model 3612-06 with Standard Remote Port, PMT Corporation, Chanhassen, MN) underwent evaluation for magnetic field interactions (translational attraction and torque), MRI-related heating, and artifacts using standardized techniques. Heating was evaluated by placing the implant in a gelled-saline-filled phantom and MRI was performed using a transmit/receive RF body coil at an MR system reported, whole body averaged specific absorption rate of 2.9-W/kg. Artifacts were characterized using T1-weighted and GRE pulse sequences. Magnetic field interactions were not substantial and, thus, will not pose a hazard to a patient in a 3-Tesla or less MRI environment. The highest temperature rise was 1.7°C, which is physiologically inconsequential. Artifacts were large in relation to the remote port and metal connector of the implant but will only present problems if the MR imaging area of interest is where these components are located. A patient with this breast tissue expander with a remote port may safely undergo MRI at 3-Tesla or less under the conditions used for this investigation. These findings are the first reported at 3-Tesla for a tissue expander. Copyright © 2014 Elsevier Inc. All rights reserved.

Poster - 34: Clinical Implementation of Prone Breast Treatment

Energy Technology Data Exchange (ETDEWEB)

Jiang, Runqing; Fleming, Katrina; Kobeleva, Sofya; Osei, Ernest [Grand River Regional Cancer Centre (Canada)

2016-08-15

Purpose: Prone breast treatment is used to reduce acute and late toxicities for large or pendulous breast patients. This study developed and implemented the clinical workflow of prone breast radiotherapy treatment. Methods: Varian kVue Access360™ Prone Breast Couchtop was used as prone breast board. The treatment planning (TP)is performed in Eclipse TP system. TP comparisons between supine deep inspiration breathing hold (DIBH) and prone breast; prone forward field-in-field (FinF) planning and inverse IMRT planning were performed and discussed. For the daily setup, breast coverage was assessed in the room using light field and MV imaging was used at day 1 and weekly. Results: The first ten patients are CT scanned and planned both supine and prone. The coverage was all excellent for supine DIBH plan and prone breast plan. The plan in the prone position demonstrated improvements in lung sparing comparing to the DIBH plan. Both forward FinF plan and inverse IMRT plan achieved acceptable coverage of the breast, and heart dose is comparable. Considering the daily setup variations and MLC leakage, forward FinF plan was recommended for routine clinical use. The procedure has been tested in phantom and patients were treated clinically. Conclusions: Prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. The workflow for prone breast radiation therapy has been developed and the technique is ready to treat patients.

Preliminary Results on Setup Precision of Prone-Lateral Patient Positioning for Whole Breast Irradiation

International Nuclear Information System (INIS)

Veldeman, Liv; Speleers, Bruno; Bakker, Marlies; Jacobs, Filip; Coghe, Marc; De Gersem, Werner; Impens, Aline; Nechelput, Sarah; De Wagter, Carlos

2010-01-01

Purpose: The aim of this study was to develop a rapid and reproducible technique for prone positioning and to compare dose-volume indices in prone and supine positions. Methods and Materials: Eighteen patients underwent computed tomography imaging for radiotherapy planning in prone and supine position. Experience was gained in the first eight patients, which lead to modifications of the Horizon prone breast board (Civco Medical Solutions, Orange City, Iowa, USA) and the patient setup technique. A unilateral breast holder (U-BH) was developed (Van de Velde, Schellebelle, Belgium) to retract the contralateral breast away from the treated breast. The technique was then applied to an additional 10 patients. The setup precision was evaluated using daily cone-beam CT. Results: Modifications to the breast board were made to secure a prone-lateral rather then a pure prone position. We evolved from a classical setup using laser marks on the patients' body to a direct breast setup using marks on the breast only. The setup precision of the direct positioning procedure with the modified breast board and the U-BH is comparable to supine setup data in the literature. Dose-volume indices for heart and lung show significantly better results for prone than for supine position, and dose homogeneity within the treated breast did not differ according to the treatment position. Conclusions: The setup precision of our prone-lateral positioning technique is comparable to supine data in literature. Our data show the advantage of prone radiotherapy to spare the lung and heart. Further research is necessary to reduce the duration of prone setup.

Simultaneous whole-body 18F-FDG PET-MRI in primary staging of breast cancer: A pilot study

International Nuclear Information System (INIS)

Taneja, Sangeeta; Jena, Amarnath; Goel, Reema; Sarin, Ramesh; Kaul, Sumaid

2014-01-01

Highlights: • Initial staging of breast cancer important in treatment planning and prognostication. • We assessed role of simultaneous 18 F-FDG PET-MRI in initial staging of breast cancer. • Primary, nodes and metastases on PET, MRI and PET-MRI for count and diagnostic confidence. • High diagnostic accuracy and confidence in detecting index and satellite lesions. • Comprehensive nodal and distant metastases staging with altered management (12 cases). - Abstract: Purpose: Accurate initial staging in breast carcinoma is important for treatment planning and for establishing the likely prognosis. The purpose of this study was to assess the utility of whole body simultaneous 18 F-FDG PET-MRI in initial staging of breast carcinoma. Methods: 36 patients with histologically confirmed invasive ductal carcinoma underwent simultaneous whole body 18 F-FDG PET-MRI on integrated 3 T PET-MR scanner (Siemens Biograph mMR) for primary staging. Primary lesion, nodes and metastases were evaluated on PET, MRI and PET-MRI for lesion count and diagnostic confidence (DC). Kappa co relation analysis was done to assess agreement between the satellite, nodal and metastatic lesions detected by PET and MRI. Histopathology, clinical/imaging follow-up served as the reference standard. Results: 36 patients with 37 histopathologically proven index breast cancer were retrospectively studied. Of 36 patients, 25 patients underwent surgery and 11 patients received systemic therapy. All index cancers were seen on PET and MR. Fused PET-MRI showed highest diagnostic confidence score of 5 as compared to PET (median 4; range 3–5) and MRI (median 4; range 4–5) alone. 2/36 (5.5%) patients were detected to have unsuspected contralateral synchronous cancer. 47 satellite lesions were detected on DCE MRI of which 23 were FDG avid with multifocality and multicentricity in 21 (58%) patients. Kappa co relation analysis revealed fair agreement for satellite lesion detection by the two modalities (κ

Real-Time MRI Navigated Ultrasound for Preoperative Tumor Evaluation in Breast Cancer Patients: Technique and Clinical Implementation

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Park, Ah Young; Seo, Bo Kyoung [Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355 (Korea, Republic of)

2016-11-01

Real-time magnetic resonance imaging (MRI) navigated ultrasound is an image fusion technique to display the results of both MRI and ultrasonography on the same monitor. This system is a promising technique to improve lesion detection and analysis, to maximize advantages of each imaging modality, and to compensate the disadvantages of both MRI and ultrasound. In evaluating breast cancer stage preoperatively, MRI and ultrasound are the most representative imaging modalities. However, sometimes difficulties arise in interpreting and correlating the radiological features between these two different modalities. This pictorial essay demonstrates the technical principles of the real-time MRI navigated ultrasound, and clinical implementation of the system in preoperative evaluation of tumor extent, multiplicity, and nodal status in breast cancer patients.

Real-time MRI navigated ultrasound for preoperative tumor evaluation in breast cancer patients: Technique and clinical implementation

Energy Technology Data Exchange (ETDEWEB)

Park, Ah Young; Seo, Bo Kyoung [Dept. of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of)

2016-09-15

Real-time magnetic resonance imaging (MRI) navigated ultrasound is an image fusion technique to display the results of both MRI and ultrasonography on the same monitor. This system is a promising technique to improve lesion detection and analysis, to maximize advantages of each imaging modality, and to compensate the disadvantages of both MRI and ultrasound. In evaluating breast cancer stage preoperatively, MRI and ultrasound are the most representative imaging modalities. However, sometimes difficulties arise in interpreting and correlating the radiological features between these two different modalities. This pictorial essay demonstrates the technical principles of the real-time MRI navigated ultrasound, and clinical implementation of the system in preoperative evaluation of tumor extent, multiplicity, and nodal status in breast cancer patients.

Breast MRI of ductal carcinoma in situ. Is there MRI role?

International Nuclear Information System (INIS)

Francescutti, G.E.; Londero, V.; Berra, I.; Del Frate, C.; Zuiani, C.; Bazzocchi, M.

2002-01-01

Background. The purpose of this study is to report our personal experience of 22 cases of ductal carcinoma in situ (DCIS) studied with magnetic resonance imaging (MRI). Patients and methods. From September 1995 to December 2001, 22 women diagnosed with DCIS lesions underwent contrast enhanced MRI within 7 days after mammographic examination. Dynamic MRI was performed with a 1 T system, using a three dimensional fast low angle shot (FLASH) pulse sequence before and after contrast media administration. We evaluated the morphologic features of the enhancement, the enhancement rate and the signal time intensity curve. Pathology was obtained in all cases. Results. The results of histopatological examination included: 15 DCIS and 7 DCIS with associated microinvasive component or microfoci of invasive ductal carcinoma (IDC). On MRI, 21 of 22 (95%) DCIS lesions showed contrast enhancement. Fourteen out of 15 pure DCIS lesions demonstrated respectively a low (3), undeterminate (5), and strong (6) enhancement. Morphologically, the enhancing lesion was focal in 7, segmental in 4, and with linear branching in 3 cases. Wash out was found in 4 cases, plateau curve in 8 and Type I curve in 2 cases. Multifocality was present in 5 cases. All DCIS with associated microinvasion demonstrated contrast enhancement: 1/7 cases showed a low enhancement, 2/7 showed an indeterminate enhancement and 4/7 showed a strong enhancement. Morphologically, the enhancing lesion was focal in 3/9, segmental in 5 and with linear branching in 1 case. The wash out was demonstrated in 3/7 cases, plateau curve in 3 and Type 1 curve in 1 case. Multifocality was present in 3 cases. Conclusions. In conclusion, the sensitivity of MRI for DCIS detection is lower than that achieved for invasive breast cancer; however, contrast-enhanced MRI can depict foci of DCIS that are mammographically occult. The MRI technique is of complementary value for a better description of tumor size and detection of additional

Intra-observer agreement in single and joint double readings of contrast-enhanced breast MRI screening for women with high genetic breast cancer risks

Directory of Open Access Journals (Sweden)

Hugo C

2013-04-01

Full Text Available Objectives: To examine intra-observer reliability (IR for lesion detection on contrast-enhanced breast magnetic resonance images (MRI for screening women at high risk of breast cancer in single and joint double readings, without case selection. Methods: Contrast-enhanced breast MRIs were interpreted twice by the same independent reader and twice in joint readings. IR was assessed for lesion detection, normal MRI identification, mass, non-mass like enhancements (NMLE and focus characterisation, and BI-RADS assessment. Results: MRI examinations for 124 breasts, 65 women (mean age 43.4y were retrospectively reviewed with 110 lesions identified. Abnormal BIRADS (3-5 classifications were found for 52.3% in single readings and 58.5% in joint readings. Seven biopsies were performed for 4 histologically confirmed cancers. IR for BI-RADS classifications was good for single (0.63, 95% CI: 0.49-0.77, and joint readings (0.77, 95% CI: 0.61-0.93. IR for background parenchymal enhancement (BPE was moderate across single (0.53, 95% CI: 0.40-0.65 and joint readings (0.44, 95% CI: 0.33-0.56. IR for BI-RADS category according to each enhancement was poor for single (0.27, 95% CI: 0.10-0.44, and higher for joint readings, (0.58, 95% CI: 0.43-0.72. Conclusions: IR in BI-RADS breast assessments or BI-RADS lesion assessments are better with joint reading in screening for women with high genetic risks, in particular for abnormal MRI (BI-RADS 3, 4 and 5.

Differentiation between benign and malignant breast lesions using quantitative diffusion-weighted sequence on 3 T MRI

International Nuclear Information System (INIS)

Tan, S.L.L.; Rahmat, K.; Rozalli, F.I.; Mohd-Shah, M.N.; Aziz, Y.F.A.; Yip, C.H.; Vijayananthan, A.; Ng, K.H.

2014-01-01

Aim: To investigate the capability and diagnostic accuracy of diffusion-weighted imaging (DWI) in differentiating benign from malignant breast lesions using 3 T magnetic resonance imaging (MRI). Materials and methods: Women with suspicious or indeterminate breast lesions detected at MRI, mammogram and/or ultrasound were recruited for dynamic contrast-enhanced (DCE)-MRI and DWI prior to their biopsy. Image fusion of DCE-MRI with apparent diffusion coefficient (ADC) map was utilized to select the region of interest (ROI) for ADC calculation in the area that showed the most avid enhancement. DWI was performed using two sets of b-values at 500 and 1000 s/mm 2 , respectively. Results: Fifty women were recruited and the final analysis comprised 44 breast lesions, 31 of which were malignant and 13 were benign. Significant results were obtained between ADC values of benign and malignant lesions (p −3 mm 2 /s for b = 500 s/mm 2 and 1.22 × 10 −3 mm 2 /s for b = 1000 s/mm 2 , respectively. The sensitivity of DCE-MRI alone was 100% with a specificity of 66.7%. When DCE-MRI was combined with b = 1000 s/mm 2 , the specificity rose to 100%, while only mildly affecting sensitivity (90.6%). No significant correlation was found between ADC values and prognostic factors, such as lymph node metastasis, tumour size, oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status, and tumour grades. Conclusion: The present study provides consistent evidence to support DWI as a diagnostic tool for breast lesion characterization. A combination of DCE-MRI with DWI is suggested to improve the sensitivity and specificity of lesion characterization

Adaptive Breast Radiation Therapy Using Modeling of Tissue Mechanics: A Breast Tissue Segmentation Study

International Nuclear Information System (INIS)

Juneja, Prabhjot; Harris, Emma J.; Kirby, Anna M.; Evans, Philip M.

2012-01-01

Purpose: To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy. Methods and Materials: Twenty-four patients receiving postlumpectomy radiation therapy for breast cancer underwent CT imaging in prone and supine positions. The whole-breast clinical target volume was outlined. Clinical target volumes were segmented into fibroglandular and fatty tissue using the following algorithms: physical density thresholding; interactive thresholding; fuzzy c-means with 3 classes (FCM3) and 4 classes (FCM4); and k-means. The segmentation algorithms were evaluated in 2 stages: first, an approach based on the assumption that the breast composition should be the same in both prone and supine position; and second, comparison of segmentation with tissue outlines from 3 experts using the Dice similarity coefficient (DSC). Breast datasets were grouped into nonsparse and sparse fibroglandular tissue distributions according to expert assessment and used to assess the accuracy of the segmentation methods and the agreement between experts. Results: Prone and supine breast composition analysis showed differences between the methods. Validation against expert outlines found significant differences (P<.001) between FCM3 and FCM4. Fuzzy c-means with 3 classes generated segmentation results (mean DSC = 0.70) closest to the experts' outlines. There was good agreement (mean DSC = 0.85) among experts for breast tissue outlining. Segmentation accuracy and expert agreement was significantly higher (P<.005) in the nonsparse group than in the sparse group. Conclusions: The FCM3 gave the most accurate segmentation of breast tissues on CT data and could therefore be used in adaptive radiation therapy-based on tissue modeling. Breast tissue segmentation

Adaptive Breast Radiation Therapy Using Modeling of Tissue Mechanics: A Breast Tissue Segmentation Study

Energy Technology Data Exchange (ETDEWEB)

Juneja, Prabhjot, E-mail: Prabhjot.Juneja@icr.ac.uk [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom); Harris, Emma J. [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom); Kirby, Anna M. [Department of Academic Radiotherapy, Royal Marsden National Health Service Foundation Trust, Sutton (United Kingdom); Evans, Philip M. [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom)

2012-11-01

Purpose: To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy. Methods and Materials: Twenty-four patients receiving postlumpectomy radiation therapy for breast cancer underwent CT imaging in prone and supine positions. The whole-breast clinical target volume was outlined. Clinical target volumes were segmented into fibroglandular and fatty tissue using the following algorithms: physical density thresholding; interactive thresholding; fuzzy c-means with 3 classes (FCM3) and 4 classes (FCM4); and k-means. The segmentation algorithms were evaluated in 2 stages: first, an approach based on the assumption that the breast composition should be the same in both prone and supine position; and second, comparison of segmentation with tissue outlines from 3 experts using the Dice similarity coefficient (DSC). Breast datasets were grouped into nonsparse and sparse fibroglandular tissue distributions according to expert assessment and used to assess the accuracy of the segmentation methods and the agreement between experts. Results: Prone and supine breast composition analysis showed differences between the methods. Validation against expert outlines found significant differences (P<.001) between FCM3 and FCM4. Fuzzy c-means with 3 classes generated segmentation results (mean DSC = 0.70) closest to the experts' outlines. There was good agreement (mean DSC = 0.85) among experts for breast tissue outlining. Segmentation accuracy and expert agreement was significantly higher (P<.005) in the nonsparse group than in the sparse group. Conclusions: The FCM3 gave the most accurate segmentation of breast tissues on CT data and could therefore be used in adaptive radiation therapy-based on tissue modeling. Breast tissue

Staging performance of whole-body DWI, PET/CT and PET/MRI in invasive ductal carcinoma of the breast.

Science.gov (United States)

Catalano, Onofrio Antonio; Daye, Dania; Signore, Alberto; Iannace, Carlo; Vangel, Mark; Luongo, Angelo; Catalano, Marco; Filomena, Mazzeo; Mansi, Luigi; Soricelli, Andrea; Salvatore, Marco; Fuin, Niccolo; Catana, Ciprian; Mahmood, Umar; Rosen, Bruce Robert

2017-07-01

The aim of the present study was to evaluate the performance of whole-body diffusion-weighted imaging (WB-DWI), whole-body positron emission tomography with computed tomography (WB-PET/CT), and whole-body positron emission tomography with magnetic resonance imaging (WB-PET/MRI) in staging patients with untreated invasive ductal carcinoma of the breast. Fifty-one women with newly diagnosed invasive ductal carcinoma of the breast underwent WB-DWI, WB-PET/CT and WB-PET/MRI before treatment. A radiologist and a nuclear medicine physician reviewed in consensus the images from the three modalities and searched for occurrence, number and location of metastases. Final staging, according to each technique, was compared. Pathology and imaging follow-up were used as the reference. WB-DWI, WB-PET/CT and WB-PET/MRI correctly and concordantly staged 33/51 patients: stage IIA in 7 patients, stage IIB in 8 patients, stage IIIC in 4 patients and stage IV in 14 patients. WB-DWI, WB-PET/CT and WB-PET/MRI incorrectly and concordantly staged 1/51 patient as stage IV instead of IIIA. Discordant staging was reported in 17/51 patients. WB-PET/MRI resulted in improved staging when compared to WB-PET/CT (50 correctly staged on WB-PET/MRI vs. 38 correctly staged on WB-PET/CT; McNemar's test; p<0.01). Comparing the performance of WB-PET/MRI and WB-DWI (43 correct) did not reveal a statistically significant difference (McNemar test, p=0.14). WB-PET/MRI is more accurate in the initial staging of breast cancer than WB-DWI and WB-PET/CT, however, the discrepancies between WB-PET/MRI and WB-DWI were not statistically significant. When available, WB-PET/MRI should be considered for staging patient with invasive ductal breast carcinoma.

Design and characterization of Stormram 4 : an MRI-compatible robotic system for breast biopsy

NARCIS (Netherlands)

Groenhuis, Vincent; Siepel, Françoise Jeanette; Veltman, Jeroen; Stramigioli, Stefano

2017-01-01

Targeting of small lesions with high precision is essential in an early phase of breast cancer for diagnosis and accurate follow up, and subsequently determines prognosis. Current techniques to diagnose breast cancer are suboptimal, and there is a need for a small, MRI-compatible robotic system able

Reactive intramammary lymph node mimicking recurrence on MRI study in a patient with prior breast conservation therapy

Directory of Open Access Journals (Sweden)

Seema A Kembhavi

2013-01-01

Full Text Available Breast conservative therapy (BCT is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.

Early prediction of the response of breast tumors to neoadjuvant chemotherapy using quantitative MRI and machine learning.

Science.gov (United States)

Mani, Subramani; Chen, Yukun; Arlinghaus, Lori R; Li, Xia; Chakravarthy, A Bapsi; Bhave, Sandeep R; Welch, E Brian; Levy, Mia A; Yankeelov, Thomas E

2011-01-01

The ability to predict early in the course of treatment the response of breast tumors to neoadjuvant chemotherapy can stratify patients based on response for patient-specific treatment strategies. Currently response to neoadjuvant chemotherapy is evaluated based on physical exam or breast imaging (mammogram, ultrasound or conventional breast MRI). There is a poor correlation among these measurements and with the actual tumor size when measured by the pathologist during definitive surgery. We tested the feasibility of using quantitative MRI as a tool for early prediction of tumor response. Between 2007 and 2010 twenty consecutive patients diagnosed with Stage II/III breast cancer and receiving neoadjuvant chemotherapy were enrolled on a prospective imaging study. Our study showed that quantitative MRI parameters along with routine clinical measures can predict responders from non-responders to neoadjuvant chemotherapy. The best predictive model had an accuracy of 0.9, a positive predictive value of 0.91 and an AUC of 0.96.

A fully automated system for quantification of background parenchymal enhancement in breast DCE-MRI

Science.gov (United States)

Ufuk Dalmiş, Mehmet; Gubern-Mérida, Albert; Borelli, Cristina; Vreemann, Suzan; Mann, Ritse M.; Karssemeijer, Nico

2016-03-01

Background parenchymal enhancement (BPE) observed in breast dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been identified as an important biomarker associated with risk for developing breast cancer. In this study, we present a fully automated framework for quantification of BPE. We initially segmented fibroglandular tissue (FGT) of the breasts using an improved version of an existing method. Subsequently, we computed BPEabs (volume of the enhancing tissue), BPErf (BPEabs divided by FGT volume) and BPErb (BPEabs divided by breast volume), using different relative enhancement threshold values between 1% and 100%. To evaluate and compare the previous and improved FGT segmentation methods, we used 20 breast DCE-MRI scans and we computed Dice similarity coefficient (DSC) values with respect to manual segmentations. For evaluation of the BPE quantification, we used a dataset of 95 breast DCE-MRI scans. Two radiologists, in individual reading sessions, visually analyzed the dataset and categorized each breast into minimal, mild, moderate and marked BPE. To measure the correlation between automated BPE values to the radiologists' assessments, we converted these values into ordinal categories and we used Spearman's rho as a measure of correlation. According to our results, the new segmentation method obtained an average DSC of 0.81 0.09, which was significantly higher (p<0.001) compared to the previous method (0.76 0.10). The highest correlation values between automated BPE categories and radiologists' assessments were obtained with the BPErf measurement (r=0.55, r=0.49, p<0.001 for both), while the correlation between the scores given by the two radiologists was 0.82 (p<0.001). The presented framework can be used to systematically investigate the correlation between BPE and risk in large screening cohorts.

Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing

DEFF Research Database (Denmark)

Hansen, Bjarke B; Bendix, Tom; Grindsted, Jacob

2015-01-01

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the influence of low-back pain (LBP) and lumbar disc degeneration (LDD) on the lumbar lordosis in weight-bearing positional magnetic resonance imaging (pMRI). SUMMARY OF BACKGROUND DATA: The lumbar lordosis increases with a change...... of position from supine to standing and is known as an essential contributor to dynamic changes. However, the lordosis may be affected by disc degeneration and pain. METHODS: Patients with LBP >40 on a 0 to 100 mm Visual Analog Scale (VAS) both during activity and rest and a sex and age-decade matching...... control group without LBP were scanned in the supine and standing position in a 0.25-T open MRI unit. LDD was graded using Pfirrmann's grading-scale. Subsequently, the L2-to-S1 lumbar lordosis angle (LA) was measured. RESULTS: Thirty-eight patients with an average VAS of 58 (±13.8) mm during rest and 75...

Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis

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Clauser, Paola; Pancot, Martina; Girometti, Rossano; Bazzocchi, Massimo; Zuiani, Chiara [University of Udine, Azienda Ospedaliero-Universitaria, ' ' S.Maria della Misericordia' ' , Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, Udine (Italy); Carbonaro, Luca A. [IRCCS Policlinico San Donato, Unit of Radiology, Milan (Italy); Sardanelli, Francesco [IRCCS Policlinico San Donato, Unit of Radiology, Milan (Italy); Universita degli Studi di Milano, Department of Biomedical Sciences of Health, Milan (Italy)

2015-10-15

To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used. Eighty-four AFs were detected in 53/135 patients (39 %, 95 %CI 31-48 %). A correlate was found for 44/84 (52 %, 95 %CI 41-63 %) at SL-US, for 20/84 (24 %, 95 %CI 11-28 %) at SL-DM, for 42/84 (50 %, 95 %CI 39-61 %) at SL-DBT, for 63/84 (75 %, 95 %CI 64-84 %) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p < 0.001), for mass or non-mass, ≤ or >10 mm, BI-RADS 4 or 5, or malignant lesions (p < 0.031). Of 21 AFs occult at both SLs, 17 were malignant (81 %, 95 %CI 58-94 %). When adding SL-DBT to SL-US, AFs detection increased from 52 % to 75 %. MR-guided biopsy is needed for the remaining 25 %. (orig.)

3T MRI of the breast with computer aided diagnosis, can it help to ...

African Journals Online (AJOL)

Objective: This study aimed to check the sensitivity of multiple newly developed 3T MRI breast sequences using CAD software, in pre sampling diagnosis of breast cancer, in an attempt to minimize unnecessary invasive sampling or surgical procedures. Patients and methods: This was a prospective study, included 120 ...

Assessment of three different software systems in the evaluation of dynamic MRI of the breast

International Nuclear Information System (INIS)

Kurz, K.D.; Steinhaus, D.; Klar, V.; Cohnen, M.; Wittsack, H.J.; Saleh, A.; Moedder, U.; Blondin, D.

2009-01-01

Objective: The aim was to compare the diagnostic performance and handling of dynamic contrast-enhanced MRI of the breast with two commercial software solutions ('CADstream' and '3TP') and one self-developed software system ('Mammatool'). Materials and methods: Identical data sets of dynamic breast MRI from 21 patients were evaluated retrospectively with all three software systems. The exams were classified according to the BI-RADS classification. The number of lesions in the parametric mapping was compared to histology or follow-up of more than 2 years. In addition, 25 quality criteria were judged by 3 independent investigators with a score from 0 to 5. Statistical analysis was performed to document the quality ranking of the different software systems. Results: There were 9 invasive carcinomas, one pure DCIS, one papilloma, one radial scar, three histologically proven changes due to mastopathy, one adenosis and two fibroadenomas. Additionally two patients with enhancing parenchyma followed with MRI for more than 3 years and one scar after breast conserving therapy were included. All malignant lesions were classified as BI-RADS 4 or 5 using all software systems and showed significant enhancement in the parametric mapping. 'CADstream' showed the best score on subjective quality criteria. '3TP' showed the lowest number of false-positive results. 'Mammatool' produced the lowest number of benign tissues indicated with parametric overlay. Conclusion: All three software programs tested were adequate for sensitive and efficient assessment of dynamic MRI of the breast. Improvements in specificity may be achievable

Assessment of three different software systems in the evaluation of dynamic MRI of the breast.

Science.gov (United States)

Kurz, K D; Steinhaus, D; Klar, V; Cohnen, M; Wittsack, H J; Saleh, A; Mödder, U; Blondin, D

2009-02-01

The aim was to compare the diagnostic performance and handling of dynamic contrast-enhanced MRI of the breast with two commercial software solutions ("CADstream" and "3TP") and one self-developed software system ("Mammatool"). Identical data sets of dynamic breast MRI from 21 patients were evaluated retrospectively with all three software systems. The exams were classified according to the BI-RADS classification. The number of lesions in the parametric mapping was compared to histology or follow-up of more than 2 years. In addition, 25 quality criteria were judged by 3 independent investigators with a score from 0 to 5. Statistical analysis was performed to document the quality ranking of the different software systems. There were 9 invasive carcinomas, one pure DCIS, one papilloma, one radial scar, three histologically proven changes due to mastopathy, one adenosis and two fibroadenomas. Additionally two patients with enhancing parenchyma followed with MRI for more than 3 years and one scar after breast conserving therapy were included. All malignant lesions were classified as BI-RADS 4 or 5 using all software systems and showed significant enhancement in the parametric mapping. "CADstream" showed the best score on subjective quality criteria. "3TP" showed the lowest number of false-positive results. "Mammatool" produced the lowest number of benign tissues indicated with parametric overlay. All three software programs tested were adequate for sensitive and efficient assessment of dynamic MRI of the breast. Improvements in specificity may be achievable.

Hybrid {sup 18}F-FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

Energy Technology Data Exchange (ETDEWEB)

Goorts, Briete; Nijnatten, Thiemo J.A. van [Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Maastricht (Netherlands); Maastricht University Medical Center, Department of Surgery, P.O. Box 5800, Maastricht (Netherlands); Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, Maastricht (Netherlands); Voeoe, Stefan; Wildberger, Joachim E.; Lobbes, Marc B.I. [Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, Maastricht (Netherlands); Kooreman, Loes F.S. [Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Maastricht (Netherlands); Maastricht University Medical Center, Department of Pathology, Maastricht (Netherlands); Boer, Maaike de [Maastricht University Medical Center, Department of Medical Oncology, Maastricht (Netherlands); Keymeulen, Kristien B.M.I. [Maastricht University Medical Center, Department of Surgery, P.O. Box 5800, Maastricht (Netherlands); Aarnoutse, Romy; Smidt, Marjolein L. [Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, Maastricht (Netherlands); Maastricht University Medical Center, Department of Surgery, P.O. Box 5800, Maastricht (Netherlands); Mottaghy, Felix M. [Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, Maastricht (Netherlands); RWTH Aachen University Hospital, Department of Nuclear Medicine, Aachen (Germany)

2017-10-15

Our purpose in this study was to assess the added clinical value of hybrid {sup 18}F-FDG-PET/MRI compared to conventional imaging for locoregional staging in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). In this prospective study, primary invasive cT2-4 N0 or cT1-4 N+ breast cancer patients undergoing NAC were included. A PET/MRI breast protocol was performed before treatment. MR images were evaluated by a breast radiologist, blinded for PET images. PET images were evaluated by a nuclear physician. Afterwards, a combined PET/MRI report was written. PET/MRI staging was compared to conventional imaging, i.e., mammography, ultrasound and MRI. The proportion of patients with a modified treatment plan based on PET/MRI findings was analyzed. A total of 40 patients was included. PET/MRI was of added clinical value in 20.0% (8/40) of patients, changing the treatment plan in 10% and confirming the malignancy of suspicious lesions on MRI in another 10%. In seven (17.5%) patients radiotherapy fields were extended because of additional or affirmative PET/MRI findings being lymph node metastases (n = 5) and sternal bone metastases (n = 2). In one (2.5%) patient radiotherapy fields were reduced because of fewer lymph node metastases on PET/MRI compared to conventional imaging. Interestingly, all treatment changes were based on differences in number of lymph nodes suspicious for metastasis or number of distant metastasis, whereas differences in intramammary tumor extent were not observed. Prior to NAC, PET/MRI shows promising results for locoregional staging compared to conventional imaging, changing the treatment plan in 10% of patients and potentially replacing PET/CT or tissue sampling in another 10% of patients. (orig.)

Angiogenesis and dynamic contrast enhanced MRI of benign and malignant breast lesions: preliminary results

International Nuclear Information System (INIS)

Liu Peifang; Bao Runxian; Niu Yun; Yu Yong

2002-01-01

Objective: To determine whether dynamic contrast enhanced MRI features of early-phase enhancement rate, enhancement amplitude, and signal intensity (SI) time course are associated with the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of malignant and benign breast lesions. Methods: Thirty-eight patients with histopathologically verified breast lesions underwent dynamic contrast enhanced MRI. SI changes during dynamic scanning were assessed quantitatively. Early-phase enhancement rate and enhancement amplitude were calculated. Time-SI curves of the lesions were obtained and classified according to their shapes as type I (which was steady enhancement to the end of the dynamic data acquisition at 7.5 min), type II (plateau of SI after avid initial contrast enhancement), or type III (washout of SI after avid initial contrast enhancement). the mean MVD and VEGF expression of the lesions were measured with immuno-histochemical staining method in all the histologic specimens by pathologists without the knowledge of the results of the MR examination. The relationships among dynamic contrast enhanced MRI features, MVD, and VEGF expression of benign and malignant breast lesions were analyzed. Results: Histology revealed 21 malignancies and 17 benign lesions. The mean MVD and VEGF expression for 21 malignant lesions were statistically higher than the mean MVD and VEGF expression for 17 benign lesions. High VEGF expression of benign and malignant breast lesions showed an association with increased MVD. Among all 38 lesions, greater (> 60%) MR early-phase enhancement rate and time-SI curve type II and III showed an association with increased MVD and higher VEGF expression level. All the differences mentioned above showed statistical significance except that the difference between VEGF expression and the distribution of curve types had no statistical significance. No significant relationships were observed between the mean of enhancement

Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI

International Nuclear Information System (INIS)

Kim, Mi Young; Cho, Nariya; Koo, Hye Ryoung; Yun, Bo La; Bae, Min Sun; Moon, Woo Kyung; Chie, Eui Kyu

2013-01-01

Background: The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR). Purpose: To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment. Material and Methods: Nineteen consecutive women (mean age, 44 years; range, 34-63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR. Results: In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR. Conclusion: In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment

MRI features of intraductal papilloma of the breast: sheep in wolf's clothing?

International Nuclear Information System (INIS)

Kurz, Kathinka D; Roy, Sumit; Saleh, Andreas; Diallo-Danebrock, Raihana; Skaane, Per

2011-01-01

Background: Intraductal papillomas often present as small, smooth masses, dilated ducts or microcalcifications at mammography and as smooth, hypoechoic masses at sonography. At magnetic resonance imaging (MRI), intraductal papillomas often present as small smooth masses, however, often with strong enhancement with type 2 or 3 time intensity curves. The result of the MR analysis is therefore not infrequently inconclusive in order to characterize the mass as benign or malignant. Purpose: To characterize the appearance of intraductal papillomas of the breast at MRI, and determine whether the application of diagnostic rules described in literature could contribute to correctly classifying the lesions as benign. Material and Methods: Twenty patients with histologically proven intraductal papillomas were included. Two radiologists independently reviewed the MR images of the breast. The BI-RADS nomenclature was used to describe morphology and contrast-enhancement kinetics. Interobserver agreement in the interpretation of the MR images by the two investigators was performed. Kappa coefficient was calculated as index for the level of agreement. Subsequently, three sets of diagnostic rules, including the Goettinger score described by Fischer and the interpretation flowcharts according to Kinkel and to Tozaki were applied to characterize whether a biopsy should be recommended or not. Results: All papillomas presented as masses on dynamic contrast-enhanced MRI. Only five papillomas showed a round, oval, or lobulated shape combined with smooth margins and continuous rise of the time intensity curve. Using the Goettinger score, biopsy would be recommended in 16 patients. Based on the interpretation flowcharts of Kinkel and of Tozaki, an additional 13 and 10 papillomas, respectively, were correctly classified as benign. Dilated ducts were visible in 10 patients. The interobserver agreement was good or excellent for all included variables. Conclusion: Including systematic analysis

Relationship between DCE-MRI morphological and functional features and histopathological characteristics of breast cancer

International Nuclear Information System (INIS)

Montemurro, Filippo; Redana, Stefania; Aglietta, Massimo; Martincich, Laura; Bertotto, Ilaria; Cellini, Lisa; Sarotto, Ivana; Ponzone, Riccardo; Sismondi, Piero; Regge, Daniele

2007-01-01

We studied whether dynamic contrast-enhanced MRI (DCE-MRI) could identify histopathological characteristics of breast cancer. Seventy-five patients with breast cancer underwent DCE-MRI followed by core biopsy. DCE-MRI findings were evaluated following the scoring system published by Fischer in 1999. In this scoring system, five DCE-MRI features, three morphological (shape, margins, enhancement kinetic) and two functional (initial peak of signal intensity (SI) increase and behavior of signal intensity curve), are defined by 14 parameters. Each parameter is assigned points ranging from 0 to 1 or 0 to 2, with higher points for those that are more likely to be associated with malignancy. The sum of all the points defines the degree of suspicion of malignancy, with a score 0 representing the lowest and 8 the highest degree of suspicion. Associations between DCE-MRI features and tumor histopathological characteristics assessed on core biopsies (histological type, grading, estrogen and progesterone receptor status, Ki67 and HER2 status) were studied by contingency tables and logistic regression analysis. We found a significant inverse association between the Fischer's score and HER2-overexpression (odds ratio-OR 0.608, p = 0.02). Based on our results, we suggest that lesions with intermediate-low suspicious DCE-MRI parameters may represent a subset of tumor with poor histopathological characteristics. (orig.)

Rupture of the Distal Biceps Tendon Combined with a Supinator Muscle Tear in a 51-Year-Old Woman: A Case Report

OpenAIRE

Nayyar, Samir; Quirno, Martin; Hasan, Saqib; Rybak, Leon; Meislin, Robert J.

2011-01-01

Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequen...

Breast density estimation from high spectral and spatial resolution MRI

Science.gov (United States)

Li, Hui; Weiss, William A.; Medved, Milica; Abe, Hiroyuki; Newstead, Gillian M.; Karczmar, Gregory S.; Giger, Maryellen L.

2016-01-01

Abstract. A three-dimensional breast density estimation method is presented for high spectral and spatial resolution (HiSS) MR imaging. Twenty-two patients were recruited (under an Institutional Review Board--approved Health Insurance Portability and Accountability Act-compliant protocol) for high-risk breast cancer screening. Each patient received standard-of-care clinical digital x-ray mammograms and MR scans, as well as HiSS scans. The algorithm for breast density estimation includes breast mask generating, breast skin removal, and breast percentage density calculation. The inter- and intra-user variabilities of the HiSS-based density estimation were determined using correlation analysis and limits of agreement. Correlation analysis was also performed between the HiSS-based density estimation and radiologists’ breast imaging-reporting and data system (BI-RADS) density ratings. A correlation coefficient of 0.91 (pdensity estimations. An interclass correlation coefficient of 0.99 (pdensity estimations. A moderate correlation coefficient of 0.55 (p=0.0076) was observed between HiSS-based breast density estimations and radiologists’ BI-RADS. In summary, an objective density estimation method using HiSS spectral data from breast MRI was developed. The high reproducibility with low inter- and low intra-user variabilities shown in this preliminary study suggest that such a HiSS-based density metric may be potentially beneficial in programs requiring breast density such as in breast cancer risk assessment and monitoring effects of therapy. PMID:28042590

Effectiveness of dynamic MRI for diagnosing pericicatricial minimal residual breast cancer following excisional biopsy

International Nuclear Information System (INIS)

Kawashima, Hiroko; Tawara, Mari; Suzuki, Masayuki; Matsui, Osamu; Kadoya, Masumi

2001-01-01

The purpose of this study was to investigate the effectiveness of dynamic MRI for diagnosing pericicatricial minimal residual breast cancer following excisional biopsy. Twenty-six patients who underwent excisional biopsy of a tumor or calcified lesion of the breast underwent gadolinium-enhanced dynamic MRI by the fat-saturated 2D fast spoiled gradient echo (SPGR) sequence (group 1), 24 patients by the spectral IR enhanced 3D fast gradient echo (Efgre3d) sequence (group 2). Pericicatricial residual cancer was confirmed histologically in 29 of the 50 patients. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRI for residual cancer diagnosis was 66, 81, 72, 83 and 63%. A nodular, thick and discontinuous enhanced rim around the scar is indicative of a residual tumor. However, false-positive findings due to granulation or proliferative fibrocystic change remain limitations

Effectiveness of dynamic MRI for diagnosing pericicatricial minimal residual breast cancer following excisional biopsy

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Kawashima, Hiroko E-mail: hirokok@med.kanazawa-u.ac.jp; Tawara, Mari; Suzuki, Masayuki; Matsui, Osamu; Kadoya, Masumi

2001-10-01

The purpose of this study was to investigate the effectiveness of dynamic MRI for diagnosing pericicatricial minimal residual breast cancer following excisional biopsy. Twenty-six patients who underwent excisional biopsy of a tumor or calcified lesion of the breast underwent gadolinium-enhanced dynamic MRI by the fat-saturated 2D fast spoiled gradient echo (SPGR) sequence (group 1), 24 patients by the spectral IR enhanced 3D fast gradient echo (Efgre3d) sequence (group 2). Pericicatricial residual cancer was confirmed histologically in 29 of the 50 patients. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRI for residual cancer diagnosis was 66, 81, 72, 83 and 63%. A nodular, thick and discontinuous enhanced rim around the scar is indicative of a residual tumor. However, false-positive findings due to granulation or proliferative fibrocystic change remain limitations.

Comparison of pharmacokinetic MRI and [18F] fluorodeoxyglucose PET in the diagnosis of breast cancer: initial experience

International Nuclear Information System (INIS)

Brix, G.; Henze, M.; Knopp, M.V.; Doll, J.; Hawighorst, H.; Lucht, R.; Junkermann, H.; Haberkorn, U.

2001-01-01

It was the aim of this methodology-oriented clinical pilot study to compare the potential of dynamic MRI and 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for the detection and characterization of breast cancer. Fourteen women with suspicious breast lesions were examined. The MRI data were acquired with a turbo fast low-angle shot sequence and analyzed using a pharmacokinetic model. Emission data were detected in the sensitive 3D modus, iteratively reconstructed, and superimposed onto corresponding transmission images. In the 14 patients, 13 breast masses with a suspicious contrast enhancement and FDG uptake were detected. For these lesions, no statistically significant correlation between evaluated MR and PET parameters was found. Of the 9 histologically confirmed carcinomas, 8 were correctly characterized with MRI and PET. Two inflammatory lesions were concordantly classified as cancer. Moreover, dynamic MRI yielded another false-positive finding. In 6 patients, PET detected occult lymph node and/or distant metastases. Although both functional imaging techniques provide independent tissue information, the results concerning the diagnosis of primary breast lesions were almost identical. An advantage of PET, however, is its ability to localize lymph node involvement and distant metastases as an integral part of the examination. (orig.)

Three-dimensional vascular mapping of the breast by using contrast-enhanced MRI: association of unilateral increased vascularity with ipsilateral breast cancer.

Science.gov (United States)

Orgüç, Şebnem; Başara, Işıl; Coşkun, Teoman; Pekindil, Gökhan

2012-01-01

We aimed to retrospectively compare three-dimensional vascular maps of both breasts obtained by dynamic magnetic resonance imaging (MRI) and determine the association of one-sided vascular prominence with ipsilateral breast cancer. MRI was performed using gadolinium in 194 cases. Two readers scored vascular density using maximum intensity projections (MIPs). Dynamic fat-saturated T1-weighted gradientecho MIPs were acquired. Two readers evaluated the MIPs, and vessels greater than 2 mm in diameter and longer than 3 cm were counted. The difference in vessel numbers detected in the two breasts determined the score. A total of 54 patients had malignant lesions (prevalence, 28%), including invasive ductal carcinoma (n=40), invasive mixed ductal-lobular carcinoma (n=5), invasive lobular carcinoma (n=3), ductal carcinoma in situ (n=3), mucinous carcinoma (n=1), medullary carcinoma (n=1), and leukemic metastasis (n=1). In 62 patients, there were benign lesions (fibroadenomas, fibrocysts), and four patients had inflammation (granulomatous mastitis in two patients, breast tuberculosis in two patients). There were 78 normal cases. When a difference of at least two vessels was scored as vascular asymmetry, the sensitivity, specificity, positive likelihood ratio (+LR), and negative (-LR) of unilaterally increased vascularity associated with ipsilateral malignancy were 69%, 92%, 8.72, and 0.34, respectively. When four infection and three post-operative cases with vascular asymmetry were excluded; prevalence, specificity, and +LR increased to 29%, 97%, and 22.8, respectively, with the same sensitivity and -LR. Differences in mean vascularity scores were evaluated with regard to tumor size. T1 and T2 tumors were not significantly different from each other. The mean score of T3 tumors differed significantly from T1 and T2 tumors. MRI vascular mapping is an effective method for determining breast tissue vascularization. Ipsilateral increased vascularity was commonly associated with

Integrated radiomic framework for breast cancer and tumor biology using advanced machine learning and multiparametric MRI.

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Parekh, Vishwa S; Jacobs, Michael A

2017-01-01

Radiomics deals with the high throughput extraction of quantitative textural information from radiological images that not visually perceivable by radiologists. However, the biological correlation between radiomic features and different tissues of interest has not been established. To that end, we present the radiomic feature mapping framework to generate radiomic MRI texture image representations called the radiomic feature maps (RFM) and correlate the RFMs with quantitative texture values, breast tissue biology using quantitative MRI and classify benign from malignant tumors. We tested our radiomic feature mapping framework on a retrospective cohort of 124 patients (26 benign and 98 malignant) who underwent multiparametric breast MR imaging at 3 T. The MRI parameters used were T1-weighted imaging, T2-weighted imaging, dynamic contrast enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI). The RFMs were computed by convolving MRI images with statistical filters based on first order statistics and gray level co-occurrence matrix features. Malignant lesions demonstrated significantly higher entropy on both post contrast DCE-MRI (Benign-DCE entropy: 5.72 ± 0.12, Malignant-DCE entropy: 6.29 ± 0.06, p  = 0.0002) and apparent diffusion coefficient (ADC) maps as compared to benign lesions (Benign-ADC entropy: 5.65 ± 0.15, Malignant ADC entropy: 6.20 ± 0.07, p  = 0.002). There was no significant difference between glandular tissue entropy values in the two groups. Furthermore, the RFMs from DCE-MRI and DWI demonstrated significantly different RFM curves for benign and malignant lesions indicating their correlation to tumor vascular and cellular heterogeneity respectively. There were significant differences in the quantitative MRI metrics of ADC and perfusion. The multiview IsoSVM model classified benign and malignant breast tumors with sensitivity and specificity of 93 and 85%, respectively, with an AUC of 0.91.

Role of quantitative pharmacokinetic parameter (transfer constant: Ktrans in the characterization of breast lesions on MRI

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Jena Amarnath

2013-01-01

Full Text Available Background: The semi-quantitative analysis of the time-intensity curves in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI has a limited specificity due to overlapping enhancement patterns after gadolinium administration. With the advances in technology and faster sequences, imaging of the entire breast can be done in a few seconds, which allows measuring the transit of contrast (transfer constant: K trans through the vascular bed at capillary level that reflects quantitative measure of porosity/permeability of tumor vessels. Aim: Our study aims to evaluate the pharmacokinetic parameter K trans for enhancing breast lesions and correlate it with histopathology, and assess accuracy, sensitivity, and specificity of this parameter in discriminating benign and malignant breast lesions. Materials and Methods: One hundred and fifty-one women with 216 histologically proved enhancing breast lesions underwent high temporal resolution DCE-MRI for the early dynamic analysis for calculation of pharmacokinetic parameters (K trans using standard two compartment model. The calculated values of K trans were correlated with histopathology to calculate the sensitivity, specificity, and accuracy. Results: Receiver operating characteristic (ROC curve analysis revealed a mean K trans value of 0.56, which reliably distinguished benign and malignant breast lesions with a sensitivity of 91.1% and specificity of 90.3% with an overall accuracy of 89.3%. The area under curve (AUC was 0.907. Conclusion: K trans is a reliable quantitative parameter for characterizing benign and malignant lesions in routine DCE-MRI of breasts.

Comparative utility of MRI perfusion with MSIDR and DWIBS for the characterization of breast tumors

International Nuclear Information System (INIS)

Zhang, Bing; Zhu, Bin; Li, Ming

2012-01-01

Background. In recent years, breast magnetic resonance imaging (MRI) has been used to evaluate the morphology and functional markers of breast lesions, which might influence local staging and surgical planning. Purpose. To evaluate the feasibility of a one stop MRI protocol combined with diffusion-weighted imaging with background body signal suppression (DWIBS), T2*-weighted perfusion imaging (T2*-PWI) and delayed contrast-enhanced T1-weighted MRI (T1W-C+). Material and Methods. All experiments were conducted with a 3-T clinical MRI scanner. The apparent diffusion coefficient (ADC) and detectability of lesions in DWIBS, the maximal signal intensity drop rate (MSIDR) in T2*-PWI and the intensity increasing rate (IIR) on T1W-C+ were compared between breast malignancies (n = 29) and benign lesions (n = 31). The time-signal curves in the T2*-PWI sequences were classified into two subtypes (a and b) according to the end of the curve. The ADC, MSIDR, the first maximal signal intensity decrease time (MSIDT), and IIR between the malignant and benign lesions were statistically analyzed by unpaired t-tests. Results. Overall, 90% of the lesions were detected by DWIBS. There were significant differences in ADC, MSIDR, and IIR between the carcinomas and benign lesions. The Ib subtype in T2*-PWI demonstrated a specificity of 66.7% in differentiating between carcinomas and benign lesions. At a fixed specificity of 93.5%, the MSIDR, IIR, and ADC differentiated breast carcinomas from benign lesions with sensitivities of 82.8%, 44.8%, and 86.2%, respectively. Conclusion. DWIBS might be a compensation sequence for detecting breast lesions in pre-contrast sequences. MSIDR from T2*-PWI had the best specificity index, and the two subtypes in the T2*-PWI curve were helpful in the differential diagnosis of carcinomas from benign lesions

Value of contrast-enhanced MRI of breast after silicone implant

International Nuclear Information System (INIS)

Heinig, A.; Heywang-Koebrunner, S.H.; Viehweg, P.; Spielmann, R.P.; Lampe, D.; Buchmann, J.

1997-01-01

Early recognition of recurrence and work-up of clinically indeterminate lesions may be impaired after reconstruction with silicone implants due to superimposition of the implant or to scarring. This study was undertaken to evaluate the use of contrast-enhanced MRI in patients with silicone implant after breast cancer. Contrast-enhanded MRI was offered to 169 patients. Comparative two- to three-view mammography was also performed in 169 patients, as well as comparative sonography in 144 patients. Conventional imaging and clinical examination detected only 8/13 recurrences, whereas 12/13 were detected by MRI. One recurrence had been visible as a strongly enhancing 2-mm dot in a previous examination (2 years before), but was not called. It was therefore counted as false negative. In addition, multicentricity was detected by MRI alone in two of three cases. MRI correctly diagnosed scar tissue in all cases with indeterminate findings. However, due to false-positive calls caused by enhancing granulomas specificity could not be improved. Contrast-enhanded MRI allowed decisive additional information in our study group and improved the sensitivity significantly (concerning all diagnoses). Contrast-enhanded MRI allowed decisive additional information in our study group and improved the sensitivity significantly (concerning all diagnoses). Contrast-enhanded MRI is recommended in patients with diagnostic problems or high risk of recurrence after silicone implants. (orig.) [de

Variability of ischiofemoral space dimensions with changes in hip flexion: an MRI study

International Nuclear Information System (INIS)

Johnson, Adam C.; Howe, Benjamin M.; Hollman, John H.; Finnoff, Jonathan T.

2017-01-01

The primary aim of this study was to determine if ischiofemoral space (IFS) dimensions vary with changes in hip flexion as a result of placing a bolster behind the knees during magnetic resonance imaging (MRI). A secondary aim was to determine if IFS dimensions vary between supine and prone hip neutral positions. The study employed a prospective design. Sports medicine center within a tertiary care institution. Five male and five female adult subjects (age mean = 29.2, range = 23-35; body mass index [BMI] mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. An axial, T1-weighted MRI sequence of the pelvis was obtained of each subject in a supine position with their hips in neutral and flexed positions, and in a prone position with their hips in neutral position. Supine hip flexion was induced by placing a standard, 9-cm-diameter MRI knee bolster under the subject's knees. The order of image acquisition (supine hip neutral, supine hip flexed, prone hip neutral) was randomized. The IFS dimensions were then measured on a separate workstation. The investigator performing the IFS measurements was blinded to the subject position for each image. The main outcome measurements were the IFS dimensions acquired with MRI. The mean IFS dimensions in the prone position were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). In the supine hip neutral position, the IFS dimensions were 25.1 (SD 5.6) mm. The mean difference between the two positions of 3.15 (3.6) mm was statistically significant (95 % CI of the difference = 1.4 to 4.8 mm, t_1_9 = 3.911, p =.001). The mean IFS dimensions in the hip flexed position were 36.9 (SD 5.7) mm. The mean difference between the two supine positions of 11.8 (4.1) mm was statistically significant (95 % CI of the difference = 9.9 to 13.7 mm, t_1_9 = 12.716, p <.001). Our findings demonstrate that the IFS measurements obtained with MRI are dependent upon patient positioning with respect to hip flexion and supine versus

Variability of ischiofemoral space dimensions with changes in hip flexion: an MRI study

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Johnson, Adam C.; Howe, Benjamin M. [Mayo Clinic College of Medicine, Department of Radiology, Rochester, MN (United States); Hollman, John H.; Finnoff, Jonathan T. [Mayo Clinic College of Medicine, Department of Physical Medicine and Rehabilitation, Rochester, MN (United States)

2017-01-15

The primary aim of this study was to determine if ischiofemoral space (IFS) dimensions vary with changes in hip flexion as a result of placing a bolster behind the knees during magnetic resonance imaging (MRI). A secondary aim was to determine if IFS dimensions vary between supine and prone hip neutral positions. The study employed a prospective design. Sports medicine center within a tertiary care institution. Five male and five female adult subjects (age mean = 29.2, range = 23-35; body mass index [BMI] mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. An axial, T1-weighted MRI sequence of the pelvis was obtained of each subject in a supine position with their hips in neutral and flexed positions, and in a prone position with their hips in neutral position. Supine hip flexion was induced by placing a standard, 9-cm-diameter MRI knee bolster under the subject's knees. The order of image acquisition (supine hip neutral, supine hip flexed, prone hip neutral) was randomized. The IFS dimensions were then measured on a separate workstation. The investigator performing the IFS measurements was blinded to the subject position for each image. The main outcome measurements were the IFS dimensions acquired with MRI. The mean IFS dimensions in the prone position were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). In the supine hip neutral position, the IFS dimensions were 25.1 (SD 5.6) mm. The mean difference between the two positions of 3.15 (3.6) mm was statistically significant (95 % CI of the difference = 1.4 to 4.8 mm, t{sub 19} = 3.911, p =.001). The mean IFS dimensions in the hip flexed position were 36.9 (SD 5.7) mm. The mean difference between the two supine positions of 11.8 (4.1) mm was statistically significant (95 % CI of the difference = 9.9 to 13.7 mm, t{sub 19} = 12.716, p <.001). Our findings demonstrate that the IFS measurements obtained with MRI are dependent upon patient positioning with respect to hip flexion and

Breast MRI in the Evaluation of Locally Recurrent or New Breast Cancer in the Postoperative Patient: Correlation of Morphology and Enhancement Features with the BI-RADS Category

International Nuclear Information System (INIS)

Seely, J.M.; Nguyen, E.T.; Jaffey, J.

2007-01-01

Background: While breast magnetic resonance imaging (MRI) is a highly sensitive test for detecting breast carcinoma, its specificity is lower, and several methods have been described on how to optimize specificity. Purpose: To compare the specificity and sensitivity of the BI-RADS category with the Fischer score in breast MRI for diagnosing cancer in women previously treated for breast cancer. Material and Methods: Women referred for evaluation of possible local recurrence or new breast cancer underwent breast MRI examination. Morphologic and kinetic enhancement characteristics were evaluated. BI-RADS category and Fischer score were assigned for each enhancing lesion and compared using a chi-square test. Sensitivity, specificity, and positive predictive values for 27 morphologic and enhancement characteristics were calculated. Pathologic diagnosis was obtained in all patients with enhancing lesions who had ultrasound or mammographic correlation. In those without correlate, 6-, 12-, and 24-month follow-up breast MRIs were obtained. Interobserver kappa correlation was determined for each variable studied. Results: 34 benign and 32 malignant lesions were identified in 26 of 30 patients. BI-RADS category yielded a specificity of 77.1% and a sensitivity of 81.8%. Fischer score had a lower specificity and sensitivity (62.9% and 72.7%, respectively) (P 100% enhancement was more sensitive than BI-RADS for malignant lesions. Specificity was highest for rim enhancement (97.1%), but sensitivity was low (24.2%). Interobserver kappa correlation was good for all 27 characteristics ( = 0.84), and highest for BI-RADS assessment ( 0.91). Conclusion: BI-RADS category in breast MRI had the highest combination of specificity and sensitivity, and the highest interobserver correlation. Fischer score and other morphologic and enhancement features lack sensitivity or specificity and do not have high positive predictive values when analyzed as single independent variables

A fast alignment method for breast MRI follow-up studies using automated breast segmentation and current-prior registration

Science.gov (United States)

Wang, Lei; Strehlow, Jan; Rühaak, Jan; Weiler, Florian; Diez, Yago; Gubern-Merida, Albert; Diekmann, Susanne; Laue, Hendrik; Hahn, Horst K.

2015-03-01

In breast cancer screening for high-risk women, follow-up magnetic resonance images (MRI) are acquired with a time interval ranging from several months up to a few years. Prior MRI studies may provide additional clinical value when examining the current one and thus have the potential to increase sensitivity and specificity of screening. To build a spatial correlation between suspicious findings in both current and prior studies, a reliable alignment method between follow-up studies is desirable. However, long time interval, different scanners and imaging protocols, and varying breast compression can result in a large deformation, which challenges the registration process. In this work, we present a fast and robust spatial alignment framework, which combines automated breast segmentation and current-prior registration techniques in a multi-level fashion. First, fully automatic breast segmentation is applied to extract the breast masks that are used to obtain an initial affine transform. Then, a non-rigid registration algorithm using normalized gradient fields as similarity measure together with curvature regularization is applied. A total of 29 subjects and 58 breast MR images were collected for performance assessment. To evaluate the global registration accuracy, the volume overlap and boundary surface distance metrics are calculated, resulting in an average Dice Similarity Coefficient (DSC) of 0.96 and root mean square distance (RMSD) of 1.64 mm. In addition, to measure local registration accuracy, for each subject a radiologist annotated 10 pairs of markers in the current and prior studies representing corresponding anatomical locations. The average distance error of marker pairs dropped from 67.37 mm to 10.86 mm after applying registration.

Assessment of three different software systems in the evaluation of dynamic MRI of the breast

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Kurz, K.D. [Department of Radiology, Stavanger University Hospital, Postbox 8100, Stavanger (Norway)], E-mail: kurk@sus.no; Steinhaus, D. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: Daniele.Steinhaus@med.uni-duesseldorf.de; Klar, V. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: verena.klar@uni-duesseldorf.de; Cohnen, M. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: cohnen@med.uni-duesseldorf.de; Wittsack, H.J. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: wittsack@uni-duesseldorf.de; Saleh, A. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: saleh@uni-duesseldorf.de; Moedder, U. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: moedder@med.uni-duesseldorf.de; Blondin, D. [Institute of Daignostic Radiology, Duesseldorf University Hospital, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de

2009-02-15

Objective: The aim was to compare the diagnostic performance and handling of dynamic contrast-enhanced MRI of the breast with two commercial software solutions ('CADstream' and '3TP') and one self-developed software system ('Mammatool'). Materials and methods: Identical data sets of dynamic breast MRI from 21 patients were evaluated retrospectively with all three software systems. The exams were classified according to the BI-RADS classification. The number of lesions in the parametric mapping was compared to histology or follow-up of more than 2 years. In addition, 25 quality criteria were judged by 3 independent investigators with a score from 0 to 5. Statistical analysis was performed to document the quality ranking of the different software systems. Results: There were 9 invasive carcinomas, one pure DCIS, one papilloma, one radial scar, three histologically proven changes due to mastopathy, one adenosis and two fibroadenomas. Additionally two patients with enhancing parenchyma followed with MRI for more than 3 years and one scar after breast conserving therapy were included. All malignant lesions were classified as BI-RADS 4 or 5 using all software systems and showed significant enhancement in the parametric mapping. 'CADstream' showed the best score on subjective quality criteria. '3TP' showed the lowest number of false-positive results. 'Mammatool' produced the lowest number of benign tissues indicated with parametric overlay. Conclusion: All three software programs tested were adequate for sensitive and efficient assessment of dynamic MRI of the breast. Improvements in specificity may be achievable.

Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers

NARCIS (Netherlands)

Lobbes, Marc B.I.; Vriens, Ingeborg J.H.; van Bommel, Annelotte C.M.; Nieuwenhuijzen, Grard A.P.; Smidt, Marjolein L.; Boersma, Liesbeth J.; van Dalen, Thijs; Smorenburg, Carolien; Struikmans, Henk; Siesling, Sabine; Voogd, Adri C.; Tjan-Heijnen, Vivianne C.G.

2017-01-01

Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer. Methods All Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with

Postoperative enhancement on breast MRI: Time course and pattern of changes.

Science.gov (United States)

Mahoney, Mary C; Sharda, Radhika G

2018-04-23

Expected postoperative enhancement on breast MRI can appear similar to enhancement seen in recurrent or residual malignancy. Our aim was to assess the time course and patterns of enhancement at the surgical site, thereby helping to distinguish between benign and malignant postoperative enhancement. In 200 MRI scans performed in 153 patients after breast conservation treatment, 43 after surgical excision of atypia, and 4 patients after benign excisional biopsy were categorized by postoperative time interval. We defined 4 patterns of morphologic enhancement on MRI: cavity wall/seroma (Pattern I); thin linear (Pattern II); mass (Pattern III); and fat necrosis (Pattern IV). Of 200 MRI scans, 66 (33%) demonstrated enhancement at the surgical site. Enhancement typically decreased through the postoperative follow-up period. Enhancement was observed in 41% (28/68) of cases beyond the 18-month interval but was uncommon after 5 years. Pattern III enhancement was the morphologic pattern seen most commonly with malignancy (5/19 cases, 26%). When associated with delayed washout kinetics, it was even more strongly predictive of malignancy (4/5 cases, 80%). In patients with a history of excisional biopsy and no prior radiation treatment, the percentage of MRI scans showing enhancement was significantly lower than (21% vs 49% with P-value .0027) in patients who had undergone radiation. Enhancement at the surgical site occurred in one-third of cases up to 5 years after surgery, particularly in patients who underwent both radiation and surgery. Mass enhancement, particularly in conjunction with delayed washout kinetics, is most predictive of malignancy and should prompt biopsy or re-excision. © 2018 Wiley Periodicals, Inc.

Is the performance of MRI in preoperative staging of breast cancer independent of clinical and histological factors? A subgroup analysis.

Science.gov (United States)

Carreira Gómez, C; Zamora Romero, J; Gil de Miguel, A; Chiva de Agustín, M; Plana Farrás, M N; Martínez González, J

2015-01-01

To determine whether preoperative breast MRI is more useful in patients according to their breast density, age, menopausal status, and biopsy findings of carcinoma in situ. We retrospectively studied 264 patients treated for breast cancer who had undergone mammography, ultrasonography, and MRI. We compared the size of the tumor on the three techniques and the sensitivity of the techniques for detecting additional lesions both in the overall group and in subgroups of patients classified according to their breast density, age, menopausal status, and histological findings of intraductal carcinoma. The definitive histological diagnosis was used as the gold standard. MRI was the technique that was most concordant with the histological findings for the size of the lesion, and it was also the technique that detected the most additional lesions. With MRI, we observed no differences in lesion size between the overall group and the subgroups in which MRI provided added value. Likewise, we observed no differences in the number of additional lesions detected in the overall group except for multicentric lesions, which was larger in older patients (P=.02). In the subgroup of patients in which MRI provided added value, the sensitivity for bilateral lesions was higher in patients with fatty breasts (P=.04). Multifocal lesions were detected significantly better in premenopausal patients (P=.03). MRI is better than mammography and better than ultrasonography for establishing the size of the tumor and for detecting additional lesions. Our results did not identify any subgroups in which the technique was more useful. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Breast MRI scan

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... or breast ultrasound Evaluate for possible rupture of breast implants Find any cancer that remains after surgery or chemotherapy Show blood ... Mean Abnormal results may be due to: Breast cancer Cysts Leaking or ruptured breast implants Abnormal breast tissue that is not cancer Scar ...

Usefulness of preoperative chest multidetector CT for evaluation of breast cancer: comparison with breast MRI

International Nuclear Information System (INIS)

Chang, Yun Woo; Kim, Dong Hun; Lee, Min Hyuk

2005-01-01

To evaluate the efficacy of chest multidetector-row helical computed tomography (MDCT) in detecting breast cancer in preoperative metastasis work-ups and to assess the accuracy of MDCT compared with magnetic resonance imaging (MRI). MDCT were performed on 69 consecutive patients with 94 lesions of histologically proven breast cancer. Retrospectively, two radiologists performed a blind review of the MDCT images for margin, shape, mass enhancement pattern and the enhancing distribution of non-mass lesions with consensus. CT attenuation values were measured in the average HU on pre-enhancing and enhanced CT in gland, fat, muscle, and in masses with the largest region of interest (ROI). MDCT finding were analyzed and compared with breast MRI. Of the 91 breast lesions detected on MDCT, 64 were mass lesions and 24 were non-mass lesions on enhancement, 86 lesions were malignant and 5 were benign. Three pathologically proven malignant masses were not detected on MDCT. Positive predictive value, false positive rate and false negative rate were 94.5%, 5.3%, 3.2% respectively. The highly predictive features for malignancy were a spiculated or irregular margin, an irregular of round shape, and a heterogeneously or rim enhanced mass. Another highly predictive feature for malignancy was linear or segmentally distributed enhancing non-mass lesions. The CT values of masses in pre-enhanced scans were 38.6 ± 7.9 HU; these values increased to 110.9 ± 26.6 HU after contrast injection (90 sec). The attenuation values from enhancing CT of malignant lesions were significantly higher than those of non-enhancing lesions. The depiction of enhancing masses on MDCT compared with MR imaging were 88.6%. The extension of malignancy were equally well correlated MDCT with MR imaging. The diagnostic value of chest MDCT for preoperative staging is comparable with MR imaging for the detection and extension of lesions. Therefore, chest MDCT of breast cancer can add to the information obtained from

The diagnosis of breast implant rupture: MRI findings compared with findings at explantation

International Nuclear Information System (INIS)

Hoelmich, Lisbet R.; Vejborg, Ilse; Conrad, Carsten; Sletting, Susanne; McLaughlin, Joseph K.

2005-01-01

Study objective: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. Material and methods: The study population consisted of 64 women with 118 implants, who had participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture (intracapsular or extracapsular), possible rupture or intact implant was then obtained. Strict predetermined rupture criteria were applied as described in this report and findings at surgery were abstracted in a standardised manner and results compared. Results: At MRI, 66 implants were diagnosed as ruptured, nine as possibly ruptured and 43 as intact. Among the ruptured implants, 27 were categorized as extracapsular. At surgery, on average 297 days after the MRI, 65 of the 66 rupture diagnoses were confirmed, as were 20 of the cases with extracapsular silicone. Eight of the nine possibly ruptured implants were in fact ruptured at surgery. Thirty-four of the 43 intact implants were described as intact at surgery. When categorising possible ruptures as ruptures, there were one false positive and nine false negative rupture diagnoses at MRI yielding an accuracy of 92%, a sensitivity of 89%, and a specificity of 97%. Correspondingly, the predictive value of a positive MRI examination was 99% and the predictive value of a negative MRI examination was 79%. Conclusions: We conclude that MRI is highly accurate for identification of silicone breast implant rupture, with a high sensitivity and specificity when evaluation of images are based on presence of well-defined rupture criteria

Quantitative Evaluation of Temporal Regularizers in Compressed Sensing Dynamic Contrast Enhanced MRI of the Breast

Directory of Open Access Journals (Sweden)

Dong Wang

2017-01-01

Full Text Available Purpose. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI is used in cancer imaging to probe tumor vascular properties. Compressed sensing (CS theory makes it possible to recover MR images from randomly undersampled k-space data using nonlinear recovery schemes. The purpose of this paper is to quantitatively evaluate common temporal sparsity-promoting regularizers for CS DCE-MRI of the breast. Methods. We considered five ubiquitous temporal regularizers on 4.5x retrospectively undersampled Cartesian in vivo breast DCE-MRI data: Fourier transform (FT, Haar wavelet transform (WT, total variation (TV, second-order total generalized variation (TGVα2, and nuclear norm (NN. We measured the signal-to-error ratio (SER of the reconstructed images, the error in tumor mean, and concordance correlation coefficients (CCCs of the derived pharmacokinetic parameters Ktrans (volume transfer constant and ve (extravascular-extracellular volume fraction across a population of random sampling schemes. Results. NN produced the lowest image error (SER: 29.1, while TV/TGVα2 produced the most accurate Ktrans (CCC: 0.974/0.974 and ve (CCC: 0.916/0.917. WT produced the highest image error (SER: 21.8, while FT produced the least accurate Ktrans (CCC: 0.842 and ve (CCC: 0.799. Conclusion. TV/TGVα2 should be used as temporal constraints for CS DCE-MRI of the breast.

Comparison of pharmacokinetic MRI and [{sup 18}F] fluorodeoxyglucose PET in the diagnosis of breast cancer: initial experience

Energy Technology Data Exchange (ETDEWEB)

Brix, G. [Research Program ' ' Radiological Diagnostics and Therapy' ' , German Cancer Research Center (DKFZ), Heidelberg (Germany); Dept. of Medical Radiation Hygiene, Federal Office for Radiation Protection, Oberschleissheim (Germany); Henze, M. [Dept. of Nuclear Medicine, Univ. of Heidelberg, Heidelberg (Germany); Knopp, M.V.; Doll, J.; Hawighorst, H. [Research Program ' ' Radiological Diagnostics and Therapy' ' , German Cancer Research Center (DKFZ), Heidelberg (Germany); Lucht, R. [Dept. of Medical Radiation Hygiene, Federal Office for Radiation Protection, Oberschleissheim (Germany); Junkermann, H. [Dept. of Gynaecological Radiology, Univ. of Heidelberg (Germany); Haberkorn, U. [Research Program ' ' Radiological Diagnostics and Therapy' ' , German Cancer Research Center (DKFZ), Heidelberg (Germany); Dept. of Nuclear Medicine, Univ. of Heidelberg, Heidelberg (Germany)

2001-10-01

It was the aim of this methodology-oriented clinical pilot study to compare the potential of dynamic MRI and 2-[{sup 18}F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for the detection and characterization of breast cancer. Fourteen women with suspicious breast lesions were examined. The MRI data were acquired with a turbo fast low-angle shot sequence and analyzed using a pharmacokinetic model. Emission data were detected in the sensitive 3D modus, iteratively reconstructed, and superimposed onto corresponding transmission images. In the 14 patients, 13 breast masses with a suspicious contrast enhancement and FDG uptake were detected. For these lesions, no statistically significant correlation between evaluated MR and PET parameters was found. Of the 9 histologically confirmed carcinomas, 8 were correctly characterized with MRI and PET. Two inflammatory lesions were concordantly classified as cancer. Moreover, dynamic MRI yielded another false-positive finding. In 6 patients, PET detected occult lymph node and/or distant metastases. Although both functional imaging techniques provide independent tissue information, the results concerning the diagnosis of primary breast lesions were almost identical. An advantage of PET, however, is its ability to localize lymph node involvement and distant metastases as an integral part of the examination. (orig.)

A feasibility study of a hybrid breast-immobilization system for early breast cancer in proton beam therapy.

Science.gov (United States)

Arimura, Takeshi; Ogino, Takashi; Yoshiura, Takashi; Matsuyama, Mitsugi; Kondo, Naoaki; Miyazaki, Hideki; Sakuragi, Akari; Ohara, Takayuki; Ogo, Etsuyo; Hishikawa, Yoshio

2017-04-01

We aimed to develop a new breast-immobilizing system for proton beam therapy (PBT) of early breast cancer (EBC) that would provide the optimum breast shape during the treatment as well as increased fixation reliability by reducing the influence of respiratory movement. The breast-immobilizing system (HyBIS; hybrid breast-immobilizing system) consists of a whole body immobilization system (WBIS), position-converting device (to change patient position), photo-scanning system, breast cup (made using a three-dimensional printer), breast cup-fitting apparatus, breast cup-holding device (to ensure the breast remains lifted in the supine position), and dedicated stretcher fixed to the WBIS (to carry the patient). We conducted a phantom experiment to evaluate the effect of the HyBIS on breast immobilization during the respiratory cycle. Thirteen markers were embedded in the right breast of a female phantom that simulated respiratory thoracic movement at an amplitude of 15 mm, and their displacements on four-dimensional computed tomography were compared between conditions with and without immobilization by HyBIS. When immobilization was applied with the HyBIS, breast protrusion was maintained in the phantom in the supine treatment position. The mean values of the anteroposterior, superoinferior, lateral, and three-dimensional (3D) displacement of the markers were 2.7 ± 1.7, 0.3 ± 0.5, 0.9 ± 0.8, and 3.1 ± 1.6 mm with HyBIS, and 5.5 ± 2.9, 0.6 ± 0.8, 0.5 ± 0.4, and 5.6 ± 2.9 mm without HyBIS, respectively; thus, the anteroposterior (P = 0.014) and 3D (P = 0.007) displacements significantly improved with HyBIS. We demonstrated that the HyBIS can help retain the protruded breast shape in the supine position during treatment and can reduce the influence of respiratory movement. Thus, the HyBIS can help to reliably and precisely perform PBT for EBC. © 2017 American Association of Physicists in Medicine.

Three-dimensional conformal breast irradiation in the prone position

Directory of Open Access Journals (Sweden)

C. Kurtman

2003-10-01

Full Text Available The prone position can be used for the planning of adjuvant radiotherapy after conservative breast surgery in order to deliver less irradiation to lung and cardiac tissue. In the present study, we compared the results of three-dimensional conformal radiotherapy planning for five patients irradiated in the supine and prone position. Tumor stage was T1N0M0 in four patients and T1N1M0 in one. All patients had been previously submitted to conservative breast surgery. Breast size was large in three patients and moderate in the other two. Irradiation in the prone position was performed using an immobilization foam pad with a hole cut into it to accommodate the breast so that it would hang down away from the chest wall. Dose-volume histograms showed that mean irradiation doses reaching the ipsilateral lung were 8.3 ± 3.6 Gy with the patient in the supine position and 1.4 ± 1.0 Gy with the patient in the prone position (P = 0.043. The values for the contralateral lung were 1.3 ± 0.7 and 0.3 ± 0.1 Gy (P = 0.043 and the values for cardiac tissue were 4.6 ± 1.6 and 3.0 ± 1.7 Gy (P = 0.079, respectively. Thus, the dose-volume histograms demonstrated that lung tissue irradiation was significantly lower with the patient in the prone position than in the supine position. Large-breasted women appeared to benefit most from irradiation in the prone position. Prone position breast irradiation appears to be a simple and effective alternative to the conventional supine position for patients with large breasts, since they are subjected to lower pulmonary doses which may cause less pulmonary side effects in the future.

Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images

Science.gov (United States)

Ashraf, Ahmed B.; Lin, Lilie; Gavenonis, Sara C.; Mies, Carolyn; Xanthopoulos, Eric; Kontos, Despina

2012-03-01

The presence of axillary lymph node metastases is the most important prognostic factor in breast cancer and can influence the selection of adjuvant therapy, both chemotherapy and radiotherapy. In this work we present a set of kinetic statistics derived from DCE-MRI for predicting axillary node status. Breast DCE-MRI images from 69 women with known nodal status were analyzed retrospectively under HIPAA and IRB approval. Axillary lymph nodes were positive in 12 patients while 57 patients had no axillary lymph node involvement. Kinetic curves for each pixel were computed and a pixel-wise map of time-to-peak (TTP) was obtained. Pixels were first partitioned according to the similarity of their kinetic behavior, based on TTP values. For every kinetic curve, the following pixel-wise features were computed: peak enhancement (PE), wash-in-slope (WIS), wash-out-slope (WOS). Partition-wise statistics for every feature map were calculated, resulting in a total of 21 kinetic statistic features. ANOVA analysis was done to select features that differ significantly between node positive and node negative women. Using the computed kinetic statistic features a leave-one-out SVM classifier was learned that performs with AUC=0.77 under the ROC curve, outperforming the conventional kinetic measures, including maximum peak enhancement (MPE) and signal enhancement ratio (SER), (AUCs of 0.61 and 0.57 respectively). These findings suggest that our DCE-MRI kinetic statistic features can be used to improve the prediction of axillary node status in breast cancer patients. Such features could ultimately be used as imaging biomarkers to guide personalized treatment choices for women diagnosed with breast cancer.

Role of magnetic resonance imaging (MRI), MR spectroscopy (MRS) and other imaging modalities in breast cancer

International Nuclear Information System (INIS)

Sharma, Uma; Virendra Kumar; Jagannathan, N.R.

2004-01-01

Breast cancer is the commonest cancer among women world over and the diagnosis continues to generate fear and turmoil in the life of patients and their families. This article describes the currently available techniques used for screening primary and recurrent breast cancers and the evaluation of therapeutic response of breast cancer with special emphasis on MRI and MRS techniques. MRI, a noninvasive technique, provides anatomic images in multiple planes enabling tissue characterization. Contrast enhanced MR studies have been found to be useful in the diagnosis of small tumors in dense breast benign diseases from malignant ones. In vivo magnetic resonance spectroscopy (MRS) is another useful technique for diagnosis and for assessing the biochemical status of normal and diseased tissues. Being noninvasive, MR techniques can be used repetitively for assessment of response of the tumor to various therapeutic regimens and for evaluating the efficacy of drugs at both the structural and molecular level. An overview of the various aspects of different imaging modalities used in breast cancer research including various in vivo MR methodologies with clinical examples is presented in this review. (author)

MRI of the breast with 2D spin-echo and gradient echo sequences in diagnostically difficult cases

International Nuclear Information System (INIS)

Allgayer, B.; Lukas, P.; Loos, W.; Kersting-Sommerhoff, B.

1993-01-01

One or both breasts of 296 patients with equivocal clinical or mammographical findings were examined with MRI. T 1 weighted spinecho (SE) and gradient echo (FFE) sequences were acquired before and after i.v. application of Gadolinium DTPA. 50 lesions with enhancement after Gd-DTPA were biopsied -26 carcinomas, 17 proliferating mastopathic tissues, 5 fibroadenomas and 1 abscess were found. Contrast enhanced MRI with 2D-SE and FFE sequences is an effective technqiue for evaluating suspicious breast lesions with high diagnostic acurracy. (orig.) [de

Breast tumor characteristics of BRCA1 and BRCA2 gene mutation carriers on MRI

International Nuclear Information System (INIS)

Veltman, J.; Mann, R.; Blickman, J.G.; Boetes, C.; Kok, T.; Obdeijn, I.M.; Hoogerbrugge, N.

2008-01-01

The appearance of malignant lesions in BRCA1 and BRCA2 mutation carriers (BRCA-MCs) on mammography and magnetic resonance imaging (MRI) was evaluated. Thus, 29 BRCA-MCs with breast cancer were retrospectively evaluated and the results compared with an age, tumor size and tumor type matched control group of 29 sporadic breast cancer cases. Detection rates on both modalities were evaluated. Tumors were analyzed on morphology, density (mammography), enhancement pattern and kinetics (MRI). Overall detection was significantly better with MRI than with mammography (55/58 vs 44/57, P = 0.021). On mammography, lesions in the BRCA-MC group were significantly more described as rounded (12//19 vs 3/13, P = 0.036) and with sharp margins (9/19 vs 1/13, P 0.024). On MRI lesions in the BRCA-MC group were significantly more described as rounded (16/27 vs 7/28, P = 0.010), with sharp margins (20/27 vs 7/28, P < 0.001) and with rim enhancement (7/27 vs 1/28, P = 0.025). No significant difference was found for enhancement kinetics (P = 0.667). Malignant lesions in BRCA-MC frequently have morphological characteristics commonly seen in benign lesions, like a rounded shape or sharp margins. This applies for both mammography and MRI. However the possibility of MRI to evaluate the enhancement pattern and kinetics enables the detection of characteristics suggestive for a malignancy. (orig.)

Indications for MRI of the breast - current status. Pt. 1

International Nuclear Information System (INIS)

Rieber, A.; Tomczak, R.; Nuessle, K.; Brambs, H.J.

1997-01-01

Since MRI is being applied as a diagnostic imaging method, there is no other field of application of MRI that has been causing debates and emotions of such controversial nature as has MRI of the breast. Advocates of the method emphasize the fact that MR mammography is capable of detecting carcinomas not shown by all other available methods, and diagnostic findings even permit identification of malignomas with a high accuracy. As a concluding statement of the analysis of the pros and cons it can be said that establishment of a routine diagnostic method offering higher sensitivity and specificity than other available methods, free of radiological risks at that, certainly would be appropriate. Those supporting MR mammography believe that this method is up to all requirements stated. However, financial constraints in the public health sector demand that the range of indications be well defined. (orig./AJ) [de

Full automatic fiducial marker detection on coil arrays for accurate instrumentation placement during MRI guided breast interventions

Science.gov (United States)

Filippatos, Konstantinos; Boehler, Tobias; Geisler, Benjamin; Zachmann, Harald; Twellmann, Thorsten

2010-02-01

With its high sensitivity, dynamic contrast-enhanced MR imaging (DCE-MRI) of the breast is today one of the first-line tools for early detection and diagnosis of breast cancer, particularly in the dense breast of young women. However, many relevant findings are very small or occult on targeted ultrasound images or mammography, so that MRI guided biopsy is the only option for a precise histological work-up [1]. State-of-the-art software tools for computer-aided diagnosis of breast cancer in DCE-MRI data offer also means for image-based planning of biopsy interventions. One step in the MRI guided biopsy workflow is the alignment of the patient position with the preoperative MR images. In these images, the location and orientation of the coil localization unit can be inferred from a number of fiducial markers, which for this purpose have to be manually or semi-automatically detected by the user. In this study, we propose a method for precise, full-automatic localization of fiducial markers, on which basis a virtual localization unit can be subsequently placed in the image volume for the purpose of determining the parameters for needle navigation. The method is based on adaptive thresholding for separating breast tissue from background followed by rigid registration of marker templates. In an evaluation of 25 clinical cases comprising 4 different commercial coil array models and 3 different MR imaging protocols, the method yielded a sensitivity of 0.96 at a false positive rate of 0.44 markers per case. The mean distance deviation between detected fiducial centers and ground truth information that was appointed from a radiologist was 0.94mm.

A modified Seeded Region Growing algorithm for vessel segmentation in breast MRI images for investigating the nature of potential lesions

Science.gov (United States)

Glotsos, D.; Vassiou, K.; Kostopoulos, S.; Lavdas, El; Kalatzis, I.; Asvestas, P.; Arvanitis, D. L.; Fezoulidis, I. V.; Cavouras, D.

2014-03-01

The role of Magnetic Resonance Imaging (MRI) as an alternative protocol for screening of breast cancer has been intensively investigated during the past decade. Preliminary research results have indicated that gadolinium-agent administrative MRI scans may reveal the nature of breast lesions by analyzing the contrast-agent's uptake time. In this study, we attempt to deduce the same conclusion, however, from a different perspective by investigating, using image processing, the vascular network of the breast at two different time intervals following the administration of gadolinium. Twenty cases obtained from a 3.0-T MRI system (SIGNA HDx; GE Healthcare) were included in the study. A new modification of the Seeded Region Growing (SRG) algorithm was used to segment vessels from surrounding background. Delineated vessels were investigated by means of their topology, morphology and texture. Results have shown that it is possible to estimate the nature of the lesions with approximately 94.4% accuracy, thus, it may be claimed that the breast vascular network does encodes useful, patterned, information, which can be used for characterizing breast lesions.

Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI

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Song, Sung Eun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Cho, Nariya [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Centre, Institute of Radiation Medicine, Seoul (Korea, Republic of); Han, Wonshik [Seoul National University Hospital, Department of Surgery, Seoul (Korea, Republic of)

2017-12-15

To evaluate whether the post-clip placement MRI following second-look ultrasound (US)-guided core biopsy is useful to confirm the adequate sampling of suspicious lesions identified on breast MRI. Between 2014 and 2016, 31 consecutive women with 34 suspicious lesions that had not been identified on previous mammography or US were detected using MRI. Among them, 26 women with 29 lesions (mean size 1.5 cm, range 0.5-5.8 cm) found by second-look US underwent US-guided biopsy, subsequent clip insertion and post-clip placement MRI. Five women with five lesions that were not found by second-look US underwent MRI-guided biopsy. The technical success rate and lesion characteristics were described. The technical success rate was 96.6% (28/29). One failure case was a benign, 1.1-cm non-mass enhancement. Of the 28 success cases, 23 (82.1%) were masses and 5 (17.9%) were non-mass enhancements; 17 (60.7%) were benign, 4 (14.3%) were high-risk and 7 (25.0%) were malignant lesions. The technical success rate was 100% (28/28) for masses and 83.3% (5/6) for non-mass enhancements. Post-clip placement MRI following US-guided biopsy is useful in confirming the adequate sampling of lesions identified on MRI. This method could be an alternative to MRI-guided biopsy for lesions visible on US. (orig.)

Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI

International Nuclear Information System (INIS)

Song, Sung Eun; Cho, Nariya; Han, Wonshik

2017-01-01

To evaluate whether the post-clip placement MRI following second-look ultrasound (US)-guided core biopsy is useful to confirm the adequate sampling of suspicious lesions identified on breast MRI. Between 2014 and 2016, 31 consecutive women with 34 suspicious lesions that had not been identified on previous mammography or US were detected using MRI. Among them, 26 women with 29 lesions (mean size 1.5 cm, range 0.5-5.8 cm) found by second-look US underwent US-guided biopsy, subsequent clip insertion and post-clip placement MRI. Five women with five lesions that were not found by second-look US underwent MRI-guided biopsy. The technical success rate and lesion characteristics were described. The technical success rate was 96.6% (28/29). One failure case was a benign, 1.1-cm non-mass enhancement. Of the 28 success cases, 23 (82.1%) were masses and 5 (17.9%) were non-mass enhancements; 17 (60.7%) were benign, 4 (14.3%) were high-risk and 7 (25.0%) were malignant lesions. The technical success rate was 100% (28/28) for masses and 83.3% (5/6) for non-mass enhancements. Post-clip placement MRI following US-guided biopsy is useful in confirming the adequate sampling of lesions identified on MRI. This method could be an alternative to MRI-guided biopsy for lesions visible on US. (orig.)

SU-F-I-16: Short Breast MRI with High-Resolution T2-Weighted and Dynamic Contrast Enhanced T1-Weighted Images

International Nuclear Information System (INIS)

Ma, J; Son, J; Arun, B; Hazle, J; Hwang, K; Madewell, J; Yang, W; Dogan, B; Wang, K; Bayram, E

2016-01-01

Purpose: To develop and demonstrate a short breast (sb) MRI protocol that acquires both T2-weighted and dynamic contrast-enhanced T1-weighted images in approximately ten minutes. Methods: The sb-MRI protocol consists of two novel pulse sequences. The first is a flexible fast spin-echo triple-echo Dixon (FTED) sequence for high-resolution fat-suppressed T2-weighted imaging, and the second is a 3D fast dual-echo spoiled gradient sequence (FLEX) for volumetric fat-suppressed T1-weighted imaging before and post contrast agent injection. The flexible FTED sequence replaces each single readout during every echo-spacing period of FSE with three fast-switching bipolar readouts to produce three raw images in a single acquisition. These three raw images are then post-processed using a Dixon algorithm to generate separate water-only and fat-only images. The FLEX sequence acquires two echoes using dual-echo readout after each RF excitation and the corresponding images are post-processed using a similar Dixon algorithm to yield water-only and fat-only images. The sb-MRI protocol was implemented on a 3T MRI scanner and used for patients who had undergone concurrent clinical MRI for breast cancer screening. Results: With the same scan parameters (eg, spatial coverage, field of view, spatial and temporal resolution) as the clinical protocol, the total scan-time of the sb-MRI protocol (including the localizer, bilateral T2-weighted, and dynamic contrast-enhanced T1-weighted images) was 11 minutes. In comparison, the clinical breast MRI protocol took 43 minutes. Uniform fat suppression and high image quality were consistently achieved by sb-MRI. Conclusion: We demonstrated a sb-MRI protocol comprising both T2-weighted and dynamic contrast-enhanced T1-weighted images can be performed in approximately ten minutes. The spatial and temporal resolution of the images easily satisfies the current breast MRI accreditation guidelines by the American College of Radiology. The protocol has the

SU-F-I-16: Short Breast MRI with High-Resolution T2-Weighted and Dynamic Contrast Enhanced T1-Weighted Images

Energy Technology Data Exchange (ETDEWEB)

Ma, J; Son, J; Arun, B; Hazle, J; Hwang, K; Madewell, J; Yang, W; Dogan, B [UT MD Anderson Cancer Center, Houston, TX (United States); Wang, K; Bayram, E [GE Healthcare Technologies, Waukesha, Wisconsin (United States)

2016-06-15

Purpose: To develop and demonstrate a short breast (sb) MRI protocol that acquires both T2-weighted and dynamic contrast-enhanced T1-weighted images in approximately ten minutes. Methods: The sb-MRI protocol consists of two novel pulse sequences. The first is a flexible fast spin-echo triple-echo Dixon (FTED) sequence for high-resolution fat-suppressed T2-weighted imaging, and the second is a 3D fast dual-echo spoiled gradient sequence (FLEX) for volumetric fat-suppressed T1-weighted imaging before and post contrast agent injection. The flexible FTED sequence replaces each single readout during every echo-spacing period of FSE with three fast-switching bipolar readouts to produce three raw images in a single acquisition. These three raw images are then post-processed using a Dixon algorithm to generate separate water-only and fat-only images. The FLEX sequence acquires two echoes using dual-echo readout after each RF excitation and the corresponding images are post-processed using a similar Dixon algorithm to yield water-only and fat-only images. The sb-MRI protocol was implemented on a 3T MRI scanner and used for patients who had undergone concurrent clinical MRI for breast cancer screening. Results: With the same scan parameters (eg, spatial coverage, field of view, spatial and temporal resolution) as the clinical protocol, the total scan-time of the sb-MRI protocol (including the localizer, bilateral T2-weighted, and dynamic contrast-enhanced T1-weighted images) was 11 minutes. In comparison, the clinical breast MRI protocol took 43 minutes. Uniform fat suppression and high image quality were consistently achieved by sb-MRI. Conclusion: We demonstrated a sb-MRI protocol comprising both T2-weighted and dynamic contrast-enhanced T1-weighted images can be performed in approximately ten minutes. The spatial and temporal resolution of the images easily satisfies the current breast MRI accreditation guidelines by the American College of Radiology. The protocol has the

Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--Comparison to contrast-enhanced breast MRI.

Science.gov (United States)

Chou, Chen-Pin; Lewin, John M; Chiang, Chia-Ling; Hung, Bao-Hui; Yang, Tsung-Lung; Huang, Jer-Shyung; Liao, Jia-Bin; Pan, Huay-Ben

2015-12-01

To compare the diagnostic accuracy of contrast-enhanced digital mammography (CEDM) and contrast-enhanced tomosynthesis (CET) to dynamic contrast enhanced breast MRI (DCE-MRI) using a multireader-multicase study. Institutional review board approval and informed consents were obtained. Total 185 patients (mean age 51.3) with BI-RADS 4 or 5 lesions were evaluated before biopsy with mammography, tomosynthesis, CEDM, CET and DCE-MRI. Mediolateral-oblique and cranio-caudal views of the target breast CEDM and CET were acquired at 2 and 4 min after contrast agent injection. A mediolateral-oblique view of the non-target breast was taken at 6 min. Each lesion was scored with forced BI-RADS categories by three readers. Each reader interpreted lesions in the following order: mammography, tomosynthesis, CEDM, CET, and DCE-MRI during a single reading session. Histology showed 81 cancers and 144 benign lesions in the study. Of the 81 malignant lesions, 44% (36/81) were invasive and 56% (45/81) were non-invasive. Areas under the ROC curve, averaged for the 3 readers, were as follows: 0.897 for DCE-MRI, 0.892 for CET, 0.878 for CEDM, 0.784 for tomosynthesis and 0.740 for mammography. Significant differences in AUC were found between the group of contrast enhanced modalities (CEDM, CET, DCE-MRI) and the unenhanced modalities (all p0.05). CET and CEDM may be considered as an alternative modality to MRI for following up women with abnormal mammography. All three contrast modalities were superior in accuracy to conventional digital mammography with or without tomosynthesis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Breast cancer Ki67 expression preoperative discrimination by DCE-MRI radiomics features

Science.gov (United States)

Ma, Wenjuan; Ji, Yu; Qin, Zhuanping; Guo, Xinpeng; Jian, Xiqi; Liu, Peifang

2018-02-01

To investigate whether quantitative radiomics features extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are associated with Ki67 expression of breast cancer. In this institutional review board approved retrospective study, we collected 377 cases Chinese women who were diagnosed with invasive breast cancer in 2015. This cohort included 53 low-Ki67 expression (Ki67 proliferation index less than 14%) and 324 cases with high-Ki67 expression (Ki67 proliferation index more than 14%). A binary-classification of low- vs. high- Ki67 expression was performed. A set of 52 quantitative radiomics features, including morphological, gray scale statistic, and texture features, were extracted from the segmented lesion area. Three most common machine learning classification methods, including Naive Bayes, k-Nearest Neighbor and support vector machine with Gaussian kernel, were employed for the classification and the least absolute shrink age and selection operator (LASSO) method was used to select most predictive features set for the classifiers. Classification performance was evaluated by the area under receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity. The model that used Naive Bayes classification method achieved the best performance than the other two methods, yielding 0.773 AUC value, 0.757 accuracy, 0.777 sensitivity and 0.769 specificity. Our study showed that quantitative radiomics imaging features of breast tumor extracted from DCE-MRI are associated with breast cancer Ki67 expression. Future larger studies are needed in order to further evaluate the findings.

Controlling the Stormram 2: An MRI-compatible Robotic System for Breast Biopsy

NARCIS (Netherlands)

Abdelaziz, Mohamed E.M.K.; Groenhuis, Vincent; Veltman, Jeroen; Siepel, Françoise Jeanette; Stramigioli, Stefano

2017-01-01

Breast cancer is the most frequently life-threatening diagnosed type of cancer among women. Early and accurate diagnosis by acquiring a tissue sample using biopsy techniques is essential. However, small lesions only visible by MRI are often missed in standard methods, indicating the need for a

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

Energy Technology Data Exchange (ETDEWEB)

Preibsch, H.; Wanner, L.; Bahrs, S.D.; Wietek, B.M.; Nikolaou, K.; Wiesinger, B. [University Hospital Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany); Siegmann-Luz, K.C. [Diagnostic Center for Breast Cancer and Screening Mammography Brandenburg Ost, Koenigs Wusterhausen (Germany); Oberlecher, E.; Hahn, M. [University Hospital Tuebingen, Department of Gynecology and Obstetrics, Tuebingen (Germany); Staebler, A. [University Hospital Tuebingen, Institute of Pathology and Neuropathology, Tuebingen (Germany)

2016-06-15

To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC). 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. 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). BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response. (orig.)

Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment?

Science.gov (United States)

Bansal, Gaurav J; Santosh, Divya; Davies, Eleri L

2016-01-01

The purpose of this study was to evaluate whether high mammographic density can be used as one of the selection criteria for MRI in invasive lobular breast cancer (ILC). In our institute, high breast density has been used as one of the indications for performing MRI scan in patients with ILC. We divided the patients in two groups, one with MRI performed pre-operatively and other without MRI. We compared their surgical procedures and analyzed whether surgical plan was altered after MRI. In case of alteration of plan, we analyzed whether the change was adequate by comparing post-operative histological findings. Between 2011 and 2015, there were a total of 1601 breast cancers with 97 lobular cancers, out of which 36 had pre-operative MRI and 61 had no MRI scan. 12 (33.3%) had mastectomy following MRI, out of which 9 (25%) had change in surgical plan from conservation to mastectomy following MRI. There were no unnecessary mastectomies in the MRI group. However, utilization of MRI in this cohort of patients did not reduce reoperation rate (19.3%). Lobular carcinoma in situ (LCIS) was identified in 60% of reoperations on post-surgical histology. Patients in the "No MRI" group had higher mastectomy rate 26 (42.6%), which was again appropriate. High mammographic density is a useful risk stratification criterion for selective MRI in ILC within a multidisciplinary team meeting setting. Provided additional lesions identified on MRI are confirmed with biopsy, pre-operative MRI does not cause unnecessary mastectomies. Used in this selective manner, reoperation rates were not eliminated, albeit reduced when compared to literature. High mammographic breast density can be used as one of the selection criteria for pre-operative MRI in ILC without an increase in inappropriate mastectomies with potential time and cost savings. In this cohort, re-excisions were not reduced markedly with pre-operative MRI.

High resolution MRI of the breast at 3 T: which BI-RADS {sup registered} descriptors are most strongly associated with the diagnosis of breast cancer?

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Pinker-Domenig, K.; Helbich, T.H. [Medical University Vienna, Dept. of Radiology, Division of Molecular and Gender Imaging, Vienna (Austria); Bogner, W.; Gruber, S. [Medical University Vienna, Dept. of Radiology, MR Centre of Excellence, Vienna (Austria); Medical University Vienna, Dept. of Radiology, Vienna (Austria); Bickel, H. [Medical University Vienna, Dept. of Radiology, Division of Molecular and Gender Imaging, Vienna (Austria); Medical University Vienna, Dept. of Radiology, Vienna (Austria); Duffy, S. [Queen Mary University of London, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London (United Kingdom); Schernthaner, M. [Medical University Vienna, Dept. of Radiology, Vienna (Austria); Dubsky, P. [Medical University Vienna, Dept. of Surgery, Vienna (Austria); Pluschnig, U. [Medical University Vienna, Dept. of Internal Medicine, Division of Oncology, Vienna (Austria); Rudas, M. [Medical University Vienna, Clinical Institute of Pathology, Vienna (Austria); Trattnig, S. [Medical University Vienna, Dept. of Radiology, MR Centre of Excellence, Vienna (Austria)

2012-02-15

To identify which breast lesion descriptors in the ACR BI-RADS registered MRI lexicon are most strongly associated with the diagnosis of breast cancer when performing breast MR imaging at 3 T. 150 patients underwent breast MR imaging at 3 T. Lesion size, morphology and enhancement kinetics were assessed according to the BI-RADS {sup registered} classification. Sensitivity, specificity and diagnostic accuracy were assessed. The effects of the BI-RADS {sup registered} descriptors on sensitivity and specificity were evaluated. Data were analysed using logistic regression. Histopathological diagnoses were used as the standard of reference. The sensitivity, specificity and diagnostic accuracy of breast MRI at 3 T was 99%, 81% and 93%, respectively. In univariate analysis, the final diagnosis of malignancy was positively associated with irregular shape (p < 0.001), irregular margin (p < 0.001), heterogeneous enhancement (p < 0.001), Type 3 enhancement kinetics (p = 0.02), increasing patient age (p = 0.02) and larger lesion size (p < 0.001). In multivariate analysis, significant associations with malignancy remained for mass shape (p = 0.06), mass margin (p < 0.001), internal enhancement pattern (p = 0.03) and Type 3 enhancement kinetics (p = 0.06). The ACR BI-RADS {sup registered} breast lesion descriptors that are mostly strongly associated with breast cancer in breast MR imaging at 3 T are lesion shape, lesion margin, internal enhancement pattern and Type 3 enhancement kinetics. (orig.)

Supine proton beam craniospinal radiotherapy using a novel tabletop adapter

International Nuclear Information System (INIS)

Buchsbaum, Jeffrey C.; Besemer, Abby; Simmons, Joseph; Hoene, Ted; Simoneaux, Victor; Sandefur, Amy; Wolanski, Mark; Li, Zhao; Cheng, Chee-Wei

2013-01-01

To develop a device that allows supine craniospinal proton and photon therapy to the vast majority of proton and photon facilities currently experiencing limitations as a result of couch design issues. Plywood and carbon fiber were used for the development of a prototype unit. Once this was found to be satisfactory after all design issues were addressed, computer-assisted design (CAD) was used and carbon fiber tables were built to our specifications at a local manufacturer of military and racing car carbon fiber parts. Clinic-driven design was done using real-time team discussion for a prototype design. A local machinist was able to construct a prototype unit for us in <2 weeks after the start of our project. Once the prototype had been used successfully for several months and all development issues were addressed, a custom carbon fiber design was developed in coordination with a carbon fiber manufacturer in partnership. CAD methods were used to design the units to allow oblique fields from head to thigh on patients up to 200 cm in height. Two custom-designed carbon fiber craniospinal tabletop designs now exist: one long and one short. Four are in successful use in our facility. Their weight tolerance is greater than that of our robot table joint (164 kg). The long unit allows for working with taller patients and can be converted into a short unit as needed. An affordable, practical means of doing supine craniospinal therapy with protons or photons can be used in most locations via the use of these devices. This is important because proton therapy provides a much lower integral dose than all other therapy methods for these patients and the supine position is easier for patients to tolerate and for anesthesia delivery. These units have been successfully used for adult and pediatric supine craniospinal therapy, proton therapy using oblique beams to the low pelvis, treatment of various spine tumors, and breast-sparing Hodgkin's therapy

Supine proton beam craniospinal radiotherapy using a novel tabletop adapter

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Buchsbaum, Jeffrey C., E-mail: jbuchsba@iupui.edu [IU Health Proton Therapy Center, Bloomington, IN (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN (United States); Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN (United States); Besemer, Abby; Simmons, Joseph; Hoene, Ted; Simoneaux, Victor; Sandefur, Amy [IU Health Proton Therapy Center, Bloomington, IN (United States); Wolanski, Mark; Li, Zhao; Cheng, Chee-Wei [IU Health Proton Therapy Center, Bloomington, IN (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States)

2013-04-01

To develop a device that allows supine craniospinal proton and photon therapy to the vast majority of proton and photon facilities currently experiencing limitations as a result of couch design issues. Plywood and carbon fiber were used for the development of a prototype unit. Once this was found to be satisfactory after all design issues were addressed, computer-assisted design (CAD) was used and carbon fiber tables were built to our specifications at a local manufacturer of military and racing car carbon fiber parts. Clinic-driven design was done using real-time team discussion for a prototype design. A local machinist was able to construct a prototype unit for us in <2 weeks after the start of our project. Once the prototype had been used successfully for several months and all development issues were addressed, a custom carbon fiber design was developed in coordination with a carbon fiber manufacturer in partnership. CAD methods were used to design the units to allow oblique fields from head to thigh on patients up to 200 cm in height. Two custom-designed carbon fiber craniospinal tabletop designs now exist: one long and one short. Four are in successful use in our facility. Their weight tolerance is greater than that of our robot table joint (164 kg). The long unit allows for working with taller patients and can be converted into a short unit as needed. An affordable, practical means of doing supine craniospinal therapy with protons or photons can be used in most locations via the use of these devices. This is important because proton therapy provides a much lower integral dose than all other therapy methods for these patients and the supine position is easier for patients to tolerate and for anesthesia delivery. These units have been successfully used for adult and pediatric supine craniospinal therapy, proton therapy using oblique beams to the low pelvis, treatment of various spine tumors, and breast-sparing Hodgkin's therapy.

Gadolinium-Hematoporphyrin: new potential MRI contrast agent for detection of breast cancer cell line (MCF-7

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D Shahbazi Gahrouei

2005-09-01

Full Text Available Background: Gadolinium-porphyrins have been synthesized and are currently being investigated as magnetic resonance imaging (MRI contrast agents. This study aimed to synthesize Gd-hematoporphyrin and applicate it for in vitro detection of breast cancer cell line (MCF-7. Methods: The naturally occurring porphyrin (hematoporphyrin was inserted with gadolinium (III nitrate hexahydrate to yield Gd-H. T1 relaxation times and signal enhancement of the contrast agents were presented, and the results were compared. UV spectrophotometer measured the attachment of Gd to the cell membrane of MCF-7. Results: Most of gadolinium chloride (GdCl3 was found in the washing solution, indicate that it didn`t fixed to the breast cell membranes during incubation. Gd-DTPA showed some uptake into the MCF-7 cell membranes with incubation, however, its uptake was significantly lower than Gd-H. Conclusion: Good cell memberan uptake of Gd-porphyrin is comparable to controls, indicating selective delivery it to the breast cell line and considerable potency in diagnostic MR imaging for detection of breast cancer. Key Words: Porphyrin, Contrast agent, MRI, Hematoporphyrin, Breast cancer cell (MCF-7

Breast MRI: Are T2 IR sequences useful in the evaluation of breast lesions?

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Ballesio, Laura [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Savelli, Sara [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy)], E-mail: sarasavelli@hotmail.it; Angeletti, Marco; Porfiri, Lucio Maria; D' Ambrosio, Ilaria; Maggi, Claudia; Castro, Elisabetta Di; Bennati, Paolo; Fanelli, Gloria Pasqua [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Vestri, Anna Rita [Department of Experimental Medicine, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Manganaro, Lucia [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy)

2009-07-15

Aim: To evaluate the potential role of signal intensities calculated in T2 images as an adjunctive parameter in the analysis of mass-like enhancements classified as BIRADS (Breast Imaging Reporting and Data System) assessment categories 2, 3, 4 or 5 with the standard T1 criteria. Materials and methods: After a retrospective review of 338-breast Magnetic Resonance Imaging (MRI) performed for the evaluation of a suspicious lesion we selected a group of 65 mass-like enhancements ranging from 5 to 20 mm, classified as BIRADS assessment categories 2, 3, 4 or 5, histologically proved. In all cases we calculated the ratio between the signal intensity (SI) of the nodule and the pectoralis major muscle (LMSIR, lesion to muscle signal intensity ratio) with a multiROIs (region of interest) analysis on T2 images. A ROC analysis was performed to test the ability of the two diagnostic parameters separately considered (BIRADS and LMSIR) and combined in a new mono-dimensional variable obtained by a computerized discriminant function. Results: Histological examination assessed 34 malignant lesions (52.3%) and 31 benign lesions (47.7%). The evaluation of ROC curves gave the following results: BIRADS area under the curve (AUC) 0.913, S.E. 0.0368, LMSIR AUC 0.854, S.E. 0.0487, combined BIRADS-LMSIR AUC 0.965, S.E. 0.0191 with a definitive increase in the AUC between the overall ROC area and those of the two diagnostic modalities separately considered. Discussion: T2-weighted SI assessment with LMSIR measurement improves the diagnostic information content of standard breast MRI and can be considered a promising potential tool in the differential diagnosis of mass-like enhancements judged as borderline lesions (BIRADS 3 and 4)

Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI

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Song, Sung Eun; Park, Eun Kyung; Cho, Kyu Ran; Cho, Sung Bum [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seo, Bo Kyoung [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Woo, Ok Hee [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Jung, Seung Pil [Korea University Anam Hospital, Korea University College of Medicine, Department of Surgery, Seoul (Korea, Republic of)

2017-11-15

To investigate whether diffusion-weighted imaging (DWI) aids pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate additional lesions in breast cancer patients. DCE-MRI and DWI were performed on 131 lesions, with available histopathological results. The apparent diffusion coefficient (ADC) of each lesion was measured, and the cut-off value for differentiation between malignant and benign lesions was calculated. A protocol combining the ADC cut-off value with DCE-MRI was validated in a cohort of 107 lesions in 77 patients. When an ADC cut-off value of 1.11 x 10{sup -3} mm{sup 2}/s from the development cohort was applied to the additional lesions in the validation cohort, the specificity increased from 18.9% to 67.6% (P < 0.001), and the diagnostic accuracy increased from 61.7% to 82.2% (P = 0.05), without significant loss of sensitivity (98.6% vs. 90.0%, P = 0.07). The negative predictive values of lesions in the same quadrant had decreased, as had those of lesions ≥1 cm in diameter. The ADC cut-off value in the validation cohort was 1.05 x 10{sup -3} mm{sup 2}/s. Additional implementation of DWI for breast lesions in pre-operative MRI can help to obviate unnecessary biopsies by increasing specificity. However, to avoid missing cancers, clinicians should closely monitor lesions located in the same quadrant or lesions ≥1 cm. (orig.)

MRI features of intraductal papilloma of the breast: sheep in wolf's clothing?

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Kurz, Kathinka D; Roy, Sumit (Dept. of Radiology, Stavanger Univ. Hospital, Stavanger (Norway)), e-mail: kurk@sus.no; Saleh, Andreas (Inst. of Diagnostic Radiology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Diallo-Danebrock, Raihana (Inst. of Pathology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Skaane, Per (Dept. of Radiology, Ullevaal Univ. Hospital, Univ. of Oslo, Oslo (Norway))

2011-04-15

Background: Intraductal papillomas often present as small, smooth masses, dilated ducts or microcalcifications at mammography and as smooth, hypoechoic masses at sonography. At magnetic resonance imaging (MRI), intraductal papillomas often present as small smooth masses, however, often with strong enhancement with type 2 or 3 time intensity curves. The result of the MR analysis is therefore not infrequently inconclusive in order to characterize the mass as benign or malignant. Purpose: To characterize the appearance of intraductal papillomas of the breast at MRI, and determine whether the application of diagnostic rules described in literature could contribute to correctly classifying the lesions as benign. Material and Methods: Twenty patients with histologically proven intraductal papillomas were included. Two radiologists independently reviewed the MR images of the breast. The BI-RADS nomenclature was used to describe morphology and contrast-enhancement kinetics. Interobserver agreement in the interpretation of the MR images by the two investigators was performed. Kappa coefficient was calculated as index for the level of agreement. Subsequently, three sets of diagnostic rules, including the Goettinger score described by Fischer and the interpretation flowcharts according to Kinkel and to Tozaki were applied to characterize whether a biopsy should be recommended or not. Results: All papillomas presented as masses on dynamic contrast-enhanced MRI. Only five papillomas showed a round, oval, or lobulated shape combined with smooth margins and continuous rise of the time intensity curve. Using the Goettinger score, biopsy would be recommended in 16 patients. Based on the interpretation flowcharts of Kinkel and of Tozaki, an additional 13 and 10 papillomas, respectively, were correctly classified as benign. Dilated ducts were visible in 10 patients. The interobserver agreement was good or excellent for all included variables. Conclusion: Including systematic analysis

Efficacy of dynamic susceptibility contrast MRI using echo-planar imaging in differential diagnosis of breast tumors

International Nuclear Information System (INIS)

Yoshino, Ayako

1998-01-01

It has been shown that T1-weighted dynamic MR imaging is a useful method in differentiating malignant breast tumors from benign lesions. Invasive breast carcinomas enhance more rapidly than benign lesions such as fibroadenomas, papillomas, and proliferative fibrocystic diseases. However, significant overlap in the dynamic profile of benign and malignant lesions may occur, resulting in relatively low specificity, which is an inherent limitation of this technique. The author attempted to improve diagnostic accuracy by utilizing dynamic susceptibility contrast MR imaging (DSC-MRI) with a single-shot echo-planar imaging sequence. Twenty-two patients underwent DSC-MRI using a 1.5-T unit (Magnetom Vision, Siemens). Images were obtained before, during and after the bolus injection of 20 mL of gadopentetate dimeglumine. The signal reduction rate within the first 30 seconds (ΔRT2) was calculated by the following equation: ΔRT2 = (postcontrast signal intensity-precontrast signal intensity) /precontrast signal intensity. A rapid, strong decrease in signal intensity was observed on the first pass of the contrast material in all cases of carcinoma, whereas no or only a minimal decrease in signal intensity was observed in all but one of the benign lesions. This method seems to be more accurate than T1-weighted dynamic MR imaging in the differentiation benign and malignant breast lesions. Since DSC-MRI can be performed quickly, subsequent conventional T1-weighted imaging can provide additional information about the morphologic features of lesions, to further support the diagnosis. In conclusion, DSC-MRI seems to be a promising method for the accurate preoperative assessment of breast lesions. (author)

Efficacy of dynamic susceptibility contrast MRI using echo-planar imaging in differential diagnosis of breast tumors

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Yoshino, Ayako [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

1998-07-01

It has been shown that T1-weighted dynamic MR imaging is a useful method in differentiating malignant breast tumors from benign lesions. Invasive breast carcinomas enhance more rapidly than benign lesions such as fibroadenomas, papillomas, and proliferative fibrocystic diseases. However, significant overlap in the dynamic profile of benign and malignant lesions may occur, resulting in relatively low specificity, which is an inherent limitation of this technique. The author attempted to improve diagnostic accuracy by utilizing dynamic susceptibility contrast MR imaging (DSC-MRI) with a single-shot echo-planar imaging sequence. Twenty-two patients underwent DSC-MRI using a 1.5-T unit (Magnetom Vision, Siemens). Images were obtained before, during and after the bolus injection of 20 mL of gadopentetate dimeglumine. The signal reduction rate within the first 30 seconds ({Delta}RT2) was calculated by the following equation: {Delta}RT2 (postcontrast signal intensity-precontrast signal intensity) /precontrast signal intensity. A rapid, strong decrease in signal intensity was observed on the first pass of the contrast material in all cases of carcinoma, whereas no or only a minimal decrease in signal intensity was observed in all but one of the benign lesions. This method seems to be more accurate than T1-weighted dynamic MR imaging in the differentiation benign and malignant breast lesions. Since DSC-MRI can be performed quickly, subsequent conventional T1-weighted imaging can provide additional information about the morphologic features of lesions, to further support the diagnosis. In conclusion, DSC-MRI seems to be a promising method for the accurate preoperative assessment of breast lesions. (author)

Breast Cancer Redox Heterogeneity Detectable with Chemical Exchange Satruation Transfer (CEST) MRI

Science.gov (United States)

Cai, Kejia; Xu, He N.; Singh, Anup; Moon, Lily; Haris, Mohammad; Reddy, Ravinder; Li, Lin

2014-01-01

Purpose Tissue redox state is an important mediator of various biological processes in health and diseases such as cancer. Previously, we discovered that the mitochondrial redox state of ex vivo tissues detected by redox scanning (an optical imaging method) revealed interesting tumor redox state heterogeneity that could differentiate tumor aggressiveness. Because the noninvasive chemical exchange saturation transfer (CEST) MRI can probe the proton transfer and generate contrasts from endogenous metabolites, we aim to investigate if the in vivo CEST contrast is sensitive to proton transfer of the redox reactions so as to reveal the tissue redox states in breast cancer animal models. Procedures CEST MRI has been employed to characterize tumor metabolic heterogeneity and correlated with the redox states measured by the redox scanning in two human breast cancer mouse xenograft models, MDA-MB-231 and MCF-7. The possible biological mechanism on the correlation between the two imaging modalities was further investigated by phantom studies where the reductants and the oxidants of the representative redox reactions were measured. Results The CEST contrast is found linearly correlated with NADH concentration and the NADH redox ratio with high statistical significance, where NADH is the reduced form of nicotinamide adenine dinucleotide. The phantom studies showed that the reductants of the redox reactions have more CEST contrast than the corresponding oxidants, indicating that higher CEST effect corresponds to the more reduced redox state. Conclusions This preliminary study suggests that CEST MRI, once calibrated, might provide a novel noninvasive imaging surrogate for the tissue redox state and a possible diagnostic biomarker for breast cancer in the clinic. PMID:24811957

MR imaging-guided vacuum-assisted breast biopsy: Reduction of false-negative biopsies by short-term control MRI 24–48 h after biopsy

International Nuclear Information System (INIS)

Bahrs, S.D.; Hattermann, V.; Preibsch, H.; Hahn, M.; Staebler, A.; Claussen, C.D.; Siegmann-Luz, K.C.

2014-01-01

Aim: To evaluate whether another contrast-enhanced (CE) magnetic resonance imaging (MRI) examination 24–48 h after MRI-guided vacuum-assisted breast biopsy (MRI-VAB) can reduce the rate of false-negative cases. Materials and methods: The study included 252 patients who underwent MRI-VAB for the clarification of 299 lesions. The success of MRI-VAB was assessed at interventional MRI and another CE MRI 24–48 h after the intervention. In cases of successful MRI-VAB (complete or partial lesion removal) and benign histological results, follow-up breast MRI was performed. In cases of unsuccessful biopsy (unchanged lesion), tissue sampling was repeated. False-negative cases were calculated to assess the diagnostic value of MRI follow-up within 2 days after intervention. Results: Ninety-eight malignant (32.8%) and 201 (67.2%) benign lesions were diagnosed using MRI-VAB. At immediate unenhanced control MRI, all lesions were assessed as successfully biopsied. In 18 benign cases (6%), CE MRI after 24–48 h showed an unsuccessful intervention. Further tissue sampling revealed another 13 cancers in these patients. This results in a false-negative rate of 11.7%. Follow-up MRI of the benign lesions presented no further malignancy. Conclusions: MRI-VAB with immediate unenhanced control offers a success rate of 94%. The rate of false-negative biopsies (11.7%) could be reduced to zero by using short-term follow-up MRI. Therefore, a further CE breast MRI 24–48 h after benign MRI-VAB to eliminate missed cancers is recommended. - Highlights: • Some suspicious breast lesions are only seen on MRI. • They can be biopsied by a MRI-guided vacuum-assisted biopsy system. • Inadequate sampling causes some false-negative biopsies. • We evaluate an additional control MRI 24 to 48 hours after biopsy. • A reduced rate of the false-negative biopsies was found

Quantifying heterogeneity of lesion uptake in dynamic contrast enhanced MRI for breast cancer diagnosis

International Nuclear Information System (INIS)

Karahaliou, A; Skiadopoulos, S; Yiakoumelos, A; Costaridou, L; Vassiou, K; Kanavou, T

2009-01-01

The current study investigates whether texture features extracted from lesion kinetics feature maps can be used for breast cancer diagnosis. Fifty five women with 57 breast lesions (27 benign, 30 malignant) were subjected to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on 1.5T system. A linear-slope model was fitted pixel-wise to a representative lesion slice time series and fitted parameters were used to create three kinetic maps (wash out, time to peak enhancement and peak enhancement). 28 grey level co-occurrence matrices features were extracted from each lesion kinetic map. The ability of texture features per map in discriminating malignant from benign lesions was investigated using a Probabilistic Neural Network classifier. Additional classification was performed by combining classification outputs of most discriminating feature subsets from the three maps, via majority voting. The combined scheme outperformed classification based on individual maps achieving area under Receiver Operating Characteristics curve 0.960±0.029. Results suggest that heterogeneity of breast lesion kinetics, as quantified by texture analysis, may contribute to computer assisted tissue characterization in DCE-MRI.

MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques

Energy Technology Data Exchange (ETDEWEB)

Imschweiler, Thomas; Freiwald, Bianka; Kubik-Huch, Rahel A. [Kantonspital Baden AG, Institute for Radiology, Baden (Switzerland); Haueisen, Harald [Kantonspital Aarau AG, Institute for Radiology, Aarau (Switzerland); Kampmann, Gert [Clinica Sant' Anna, Lugano, Sorengo (Switzerland); Rageth, Luzi [Adjumed Services AG, Zurich (Switzerland); Seifert, Burkhardt [Institute for Social and Preventive Medicine, University of Zurich, Division of Biostatistics, Zuerich (Switzerland); Rageth, Christoph [Breast Centre, Zurich (Switzerland)

2014-01-15

To analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB. We performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided. MRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35). MRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings. (orig.)

MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard

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Maijers, M.C.; Ritt, M.J.P.F. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Niessen, F.B. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Jan van Goyen Clinic, Department of Plastic Surgery, Amsterdam (Netherlands); Veldhuizen, J.F.H. [MRI Centre, Amsterdam (Netherlands); Manoliu, R.A. [MRI Centre, Amsterdam (Netherlands); VU University Medical Centre, Department of Radiology, Amsterdam (Netherlands)

2014-06-15

The recall of Poly Implant Prothese (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study's aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage. A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard. In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92). MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon. (orig.)

MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard

International Nuclear Information System (INIS)

Maijers, M.C.; Ritt, M.J.P.F.; Niessen, F.B.; Veldhuizen, J.F.H.; Manoliu, R.A.

2014-01-01

The recall of Poly Implant Prothese (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study's aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage. A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard. In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92). MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon. (orig.)

Comparison of Lumbar Lordosis in Lateral Radiographs in Standing Position with supine MR Imaging in consideration of the Sacral Slope.

Science.gov (United States)

Benditz, Achim; Boluki, Daniel; Weber, Markus; Zeman, Florian; Grifka, Joachim; Völlner, Florian

2017-03-01

Purpose  To investigate the influence of sacral slope on the correlation between measurements of lumbar lordosis obtained by standing radiographs and magnetic resonance images in supine position (MRI). Little information is available on the correlation between measurements of lumbar lordosis obtained by radiographic and MR images. Most relevant studies have shown correlations for the thoracic spine, but detailed analyses on the lumbar spine are lacking. Methods  MR images and standing lateral radiographs of 63 patients without actual low back pain or radiographic pathologies of the lumbar spine were analyzed. Standing radiographic measurements included the sagittal parameters pelvic incidence (PI) pelvic tilt (PT), and sacral slope (SS); MR images were used to additionally measure lumbar L1-S1 lordosis and single level lordosis. Differences between radiographic and MRI measurements were analyzed and divided into 4 subgroups of different sacral slope according to Roussouly's classification. Results  Global lumbar lordosis (L1-S1) was 44.99° (± 10 754) on radiographs and 47.91° (± 9.170) on MRI, yielding a clinically relevant correlation (r = 0.61, p lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing radiographs was higher than that measured by MRI. The difference in global lumbar L1-S1 lordosis was -2.9°. Analysis of the Roussouly groups showed the largest difference for L1-S1 (-8.3°) in group 2. In group 4, when measured on MRI, L5 / S1 lordosis (25.71°) was lower than L4 / L5 lordosis (27.63°) compared to the other groups. Conclusions  Although measurements of global lumbar lordosis significantly differed between the two scanning technologies, the mean difference was just 2.9°. MRI in supine position may be used for estimating global lumbar lordosis, but single level lordosis should be determined by means of standing radiographs. Key Points   · Large

Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up.

LENUS (Irish Health Repository)

Hambly, Niamh M

2011-01-01

Background parenchymal enhancement on breast MRI refers to normal enhancement of the patient\\'s fibroglandular tissue. The aim of this study was to determine the effect of background parenchymal enhancement on short-interval follow-up, biopsy, and cancer detection rate on baseline screening MRI in a high-risk group.

Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk.

Science.gov (United States)

Grimm, Lars J; Saha, Ashirbani; Ghate, Sujata V; Kim, Connie; Soo, Mary Scott; Yoon, Sora C; Mazurowski, Maciej A

2018-03-27

To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer. All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts. Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3-4.8, P = .005). There was fair interreader agreement (κ = 0.39). High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Value of breast MRI as supplement to mammography and sonography for high risk breast cancer patients; Wertigkeit der Mamma-MRT als Ergaenzung zu Mammographie und Sonographie bei Patientinnen mit erhoehtem Mammakarzinomrisiko

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Schlossbauer, T.; Hellerhoff, K.; Reiser, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany)

2008-04-15

The aim of this study is to give an overview on early detection of breast cancer in patients with an increased risk of breast cancer. Sensitivities and diagnostic accuracies of breast MRI, mammography and ultrasound were compared. A systematic literature search of the past 3 years was performed. Studies which compared breast imaging modalities and used image-guided biopsy results as standard of reference were included. Patients included had to have had an increased lifetime risk for breast cancer (>15%). Regarding sensitivity and diagnostic accuracy, breast MRI performed best in comparison to the other modalities within this collective of patients. Sensitivities ranged from 71-100%, 0-78%, and 13-65%, for MRI, mammography, and ultrasound, respectively Breast MRI is a well established tool for screening in patients at high risk for developing breast cancer and is a valuable supplement to mammography and ultrasound within this selected cohort of patients. (orig.) [German] Ziele der Arbeit sind die inhaltliche Einfuehrung in das Thema Frueherkennung des Mammakarzinoms bei Patientinnen mit erhoehtem Risiko und eine systematische Analyse der Wertigkeit von MRT und anderen bildgebenden Verfahren in diesem Zusammenhang. Es wurde eine systematische Literaturrecherche ueber die letzten 3 Jahre durchgefuehrt. Dabei wurden Vergleichsstudien der verschiedenen bildgebenden Verfahren in der Mammadiagnostik beruecksichtigt, bei denen die bildgesteuerte Biopsie als Goldstandard angegeben wurde. Von allen bildgebenden Verfahren zeigt die Mamma-MRT bei Patientinnen mit familiaerem Risiko die hoechste Sensitivitaet und diagnostische Genauigkeit bei der Detektion des Mammakarzinoms. Fuer MRT, Mammographie und Sonographie werden Sensitivitaeten zwischen 71 und 100%, 0 und 78% sowie 13 und 65% angegeben. Die Mamma-MRT ist ein etabliertes Verfahren zum Screening von Risikopatientinnen. Uebereinstimmend wird der diagnostische Nutzen der Mamma-MRT als ergaenzendes Verfahren zu Mammographie

Photoacoustic imaging of breast tumor vascularization: a comparison with MRI and histopathology

Science.gov (United States)

Heijblom, Michelle; Piras, Daniele; van den Engh, Frank M.; Klaase, Joost M.; Brinkhuis, Mariël.; Steenbergen, Wiendelt; Manohar, Srirang

2013-06-01

Breast cancer is the most common form of cancer and the leading cause of cancer death among females. Early diagnosis improves the survival chances for the disease and that is why there is an ongoing search for improved methods for visualizing breast cancer. One of the hallmarks of breast cancer is the increase in tumor vascularization that is associated with angiogenesis: a crucial factor for survival of malignancies. Photoacoustic imaging can visualize the malignancyassociated increased hemoglobin concentration with optical contrast and ultrasound resolution, without the use of ionizing radiation or contrast agents and is therefore theoretically an ideal method for breast imaging. Previous clinical studies using the Twente Photoacoustic Mammoscope (PAM), which works in forward mode using a single wavelength (1064 nm), showed that malignancies can indeed be identified in the photoacoustic imaging volume as high contrast areas. However, the specific appearance of the malignancies led to questions about the contrast mechanism in relation to tumor vascularization. In this study, the photoacoustic lesion appearance obtained with an updated version of PAM is compared with the lesion appearance on Magnetic Resonance Imaging (MRI), both in general (19 patients) and on an individual basis (7 patients). Further, in 3 patients an extended histopathology protocol is being performed in which malignancies are stained for vascularity using an endothelial antibody: CD31. The correspondence between PAM and MRI and between PAM and histopathology makes it likely that the high photoacoustic contrast at 1064 nm is indeed largely the consequence of the increased tumor vascularization.

Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

International Nuclear Information System (INIS)

Hannan, Raquibul; Thompson, Reid F.; Chen Yu; Bernstein, Karen; Kabarriti, Rafi; Skinner, William; Chen, Chin C.; Landau, Evan; Miller, Ekeni; Spierer, Marnee; Hong, Linda; Kalnicki, Shalom

2012-01-01

Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm 3 ) (n=97) and small-breasted patients (chest wall separation 3 ) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable to that reported in the

Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer

International Nuclear Information System (INIS)

Montemurro, Filippo; Aglietta, Massimo; Martincich, Laura; Rosa, Giovanni De; Cirillo, Stefano; Marra, Vincenzo; Regge, Daniele; Biglia, Nicoletta; Sismondi, Piero; Gatti, Marco

2005-01-01

We compared dynamic contrast-enhanced MRI (DCE-MRI) and sonography (US) for monitoring tumour size in 21 patients with breast cancer undergoing primary chemotherapy (PCT) followed by surgery. The correlation between DCE-MRI and US measurements of tumour size, defined as the product of the two major diameters, was 0.555 (P=0.009), 0.782 (P 2 , P 2 , P=0.009). After PCT, the median tumour size measured by the two techniques was similar (256 vs 289 mm 2 for DCE-MRI and US, respectively, P=0.859). The correlation with the histopathological major tumour diameter was 0.824 (P<0.001) and 0.705 (P<0.001) for post-treatment DCE-MRI and US, respectively. Measurements of the final major tumour diameter by DCE-MRI tended to be more precise, including cases achieving a pathological complete response. Randomized trials are warranted to establish the clinical impact of the initial discrepancy in tumour size estimates between DCE-MRI and US, and the trend towards a better definition of the final tumour size provided by DCE-MRI in this clinical setting. (orig.)

Prospective MRI assessment for invasive lobular breast cancer. Correlation with tumour size at histopathology and influence on surgical management

International Nuclear Information System (INIS)

Muttalib, M.; Ibrahem, R.; Khashan, A.S.; Hajaj, M.

2014-01-01

Aim: To evaluate the performance of breast magnetic resonance imaging (MRI) in determining the size of invasive lobular carcinoma (ILC) compared to histopathology, and its influence on breast surgical management. Materials and methods: Prospective evaluation was undertaken of standardized contrast-enhanced MRI images of 51 consecutive women over an 18 month period with pure ILC or with lobular features as the dominant subtype on breast core biopsy. Image interpretation was performed by one consultant radiologist (M.H.). The lesion size at MRI was compared with the size at final histopathology after surgical excision using a Bland–Altman agreement plot. Results: Of the 51 prospectively imaged consecutive women, seven were excluded as they had diffuse ILC. The remaining 44 patients had a mean histological tumour size of 34.9 mm (range 4–77 mm). MRI underestimated tumour size in 26 (59.1%) cases. In 21 (47.7%) patients, this discrepancy was small, ranging up to 16 mm. The largest underestimation occurred in five (11.4%) cases with a difference ranging between 31 and 48 mm. Fifteen (34.1%) tumours were overestimated by MRI where the discrepancy ranged up to 22 mm. In three (6.8%) patients MRI and histological size matched. The Bland–Altman agreement plot demonstrated that in 95% of cases the size at histopathology will be between 0.36 and 2.31 times the MRI size at extremes. MRI correlated better with histopathology in tumours up to T2 (<5 cm) size leading to a change in surgical management for nine of the 44 (20.5%) patients. Conclusion: MRI enables surgical management decisions to be made with increased confidence in patients with ILC up to T2 size

Double-blind randomized 12-month soy intervention had no effects on breast MRI fibroglandular tissue density or mammographic density

Science.gov (United States)

Wu, Anna H.; Spicer, Darcy; Garcia, Agustin; Tseng, Chiu-Chen; Hovanessian-Larsen, Linda; Sheth, Pulin; Martin, Sue Ellen; Hawes, Debra; Russell, Christy; McDonald, Heather; Tripathy, Debu; Su, Min-Ying; Ursin, Giske; Pike, Malcolm C.

2015-01-01

Soy supplementation by breast cancer patients remains controversial. No controlled intervention studies have investigated the effects of soy supplementation on mammographic density in breast cancer patients. We conducted a double-blind, randomized, placebo-controlled intervention study in previously treated breast cancer patients (n=66) and high-risk women (n=29). We obtained digital mammograms and breast magnetic resonance imaging (MRI) scans at baseline and after 12 months of daily soy (50 mg isoflavones per day) (n=46) or placebo (n=49) tablet supplementation. The total breast area (MA) and the area of mammographic density (MD) on the mammogram was measured using a validated computer-assisted method, and mammographic density percent (MD% = 100 × MD/MA) was determined. A well-tested computer algorithm was used to quantitatively measure the total breast volume (TBV) and fibroglandular tissue volume (FGV) on the breast MRI, and the FGV percent (FGV% = 100 × FGV/TBV) was calculated. On the basis of plasma soy isoflavone levels, compliance was excellent. Small decreases in MD% measured by the ratios of month 12 to baseline levels, were seen in the soy (0.95) and the placebo (0.87) groups; these changes did not differ between the treatments (P=0.38). Small decreases in FGV% were also found in both the soy (0.90) and the placebo (0.92) groups; these changes also did not differ between the treatments (P=0.48). Results were comparable in breast cancer patients and high-risk women. We found no evidence that soy supplementation would decrease mammographic density and that MRI might be more sensitive to changes in density than mammography. PMID:26276750

Juxtafacet cysts of the lumbar spine: a positional MRI study

International Nuclear Information System (INIS)

Niggemann, Pascal; Kuchta, Johannes; Hoeffer, Janine; Beyer, Hans-Konrad; Grosskurth, Dieter; Delank, Karl-Stefan

2012-01-01

Juxtafacet cysts (JFC) are related to facet joint degeneration. Supine MRI is routinely used to evaluate JFC. However, some JFC are missed and found only intraoperatively. The present study addresses positional MRI features and factors leading to variation in the size of JFC. Fifty patients in whom positional MRI had been performed were investigated retrospectively and 67 distinct intraspinal or intraneuroforaminal were JFC found. Signal intensity, size of the JFC, the presence and variance of a vertebral slip and the angular movement of affected segments were assessed in supine, neutral sitting, flexion (sitting) and extension (standing). The overall movement of the spine and the lordosis angle in different positions were measured. JFC varied in size in segments with unstable slip and increased angular movement (variation of the angle in the affected segment in function: 13.3 degrees compared to 8.7 degrees). JFC with bright signals tended to vary in size compared to JFC with intermediate or low signal intensity (all: p < 0.001). Joint effusion and displacement of effusion lead to formation and variations in the size of JFC. JFC were most prominent in extension: 6.7 mm, less prominent in supine: 5.5 mm and in neutral sitting position: 4.6 mm (all p < 0.05). The detection rate for JFC was 97% for extension, 89% for supine and 78% for neutral sitting. The detection rate of JFC improves with increasing lordosis of the spine and under weight-bearing conditions, particularly when standing. Unstable slipping or increased angular movement affects the size of JFC. (orig.)

Juxtafacet cysts of the lumbar spine: a positional MRI study

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Niggemann, Pascal [University Hospital Bonn, Department of Radiology, Bonn (Germany); Kuchta, Johannes [Interdisziplinaeres Wirbelsaeulenzentrum, Bonn (Germany); Hoeffer, Janine; Beyer, Hans-Konrad [Upright MRT, Cologne (Germany); Grosskurth, Dieter; Delank, Karl-Stefan [Upright MRT, Cologne (Germany); University of Cologne, Department of Orthopaedic and Trauma Surgery, Cologne (Germany)

2012-03-15

Juxtafacet cysts (JFC) are related to facet joint degeneration. Supine MRI is routinely used to evaluate JFC. However, some JFC are missed and found only intraoperatively. The present study addresses positional MRI features and factors leading to variation in the size of JFC. Fifty patients in whom positional MRI had been performed were investigated retrospectively and 67 distinct intraspinal or intraneuroforaminal were JFC found. Signal intensity, size of the JFC, the presence and variance of a vertebral slip and the angular movement of affected segments were assessed in supine, neutral sitting, flexion (sitting) and extension (standing). The overall movement of the spine and the lordosis angle in different positions were measured. JFC varied in size in segments with unstable slip and increased angular movement (variation of the angle in the affected segment in function: 13.3 degrees compared to 8.7 degrees). JFC with bright signals tended to vary in size compared to JFC with intermediate or low signal intensity (all: p < 0.001). Joint effusion and displacement of effusion lead to formation and variations in the size of JFC. JFC were most prominent in extension: 6.7 mm, less prominent in supine: 5.5 mm and in neutral sitting position: 4.6 mm (all p < 0.05). The detection rate for JFC was 97% for extension, 89% for supine and 78% for neutral sitting. The detection rate of JFC improves with increasing lordosis of the spine and under weight-bearing conditions, particularly when standing. Unstable slipping or increased angular movement affects the size of JFC. (orig.)

Ultrasound imaging-guided intracardiac injection to develop a mouse model of breast cancer brain metastases followed by longitudinal MRI.

Science.gov (United States)

Zhou, Heling; Zhao, Dawen

2014-03-06

Breast cancer brain metastasis, occurring in 30% of breast cancer patients at stage IV, is associated with high mortality. The median survival is only 6 months. It is critical to have suitable animal models to mimic the hemodynamic spread of the metastatic cells in the clinical scenario. Here, we are introducing the use of small animal ultrasound imaging to guide an accurate injection of brain tropical breast cancer cells into the left ventricle of athymic nude mice. Longitudinal MRI is used to assessing intracranial initiation and growth of brain metastases. Ultrasound-guided intracardiac injection ensures not only an accurate injection and hereby a higher successful rate but also significantly decreased mortality rate, as compared to our previous manual procedure. In vivo high resolution MRI allows the visualization of hyperintense multifocal lesions, as small as 310 µm in diameter on T2-weighted images at 3 weeks post injection. Follow-up MRI reveals intracranial tumor growth and increased number of metastases that distribute throughout the whole brain.

Automated fibroglandular tissue segmentation and volumetric density estimation in breast MRI using an atlas-aided fuzzy C-means method

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Wu, Shandong; Weinstein, Susan P.; Conant, Emily F.; Kontos, Despina, E-mail: despina.kontos@uphs.upenn.edu [Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104 (United States)

2013-12-15

Purpose: Breast magnetic resonance imaging (MRI) plays an important role in the clinical management of breast cancer. Studies suggest that the relative amount of fibroglandular (i.e., dense) tissue in the breast as quantified in MR images can be predictive of the risk for developing breast cancer, especially for high-risk women. Automated segmentation of the fibroglandular tissue and volumetric density estimation in breast MRI could therefore be useful for breast cancer risk assessment. Methods: In this work the authors develop and validate a fully automated segmentation algorithm, namely, an atlas-aided fuzzy C-means (FCM-Atlas) method, to estimate the volumetric amount of fibroglandular tissue in breast MRI. The FCM-Atlas is a 2D segmentation method working on a slice-by-slice basis. FCM clustering is first applied to the intensity space of each 2D MR slice to produce an initial voxelwise likelihood map of fibroglandular tissue. Then a prior learned fibroglandular tissue likelihood atlas is incorporated to refine the initial FCM likelihood map to achieve enhanced segmentation, from which the absolute volume of the fibroglandular tissue (|FGT|) and the relative amount (i.e., percentage) of the |FGT| relative to the whole breast volume (FGT%) are computed. The authors' method is evaluated by a representative dataset of 60 3D bilateral breast MRI scans (120 breasts) that span the full breast density range of the American College of Radiology Breast Imaging Reporting and Data System. The automated segmentation is compared to manual segmentation obtained by two experienced breast imaging radiologists. Segmentation performance is assessed by linear regression, Pearson's correlation coefficients, Student's pairedt-test, and Dice's similarity coefficients (DSC). Results: The inter-reader correlation is 0.97 for FGT% and 0.95 for |FGT|. When compared to the average of the two readers’ manual segmentation, the proposed FCM-Atlas method achieves a

Automated fibroglandular tissue segmentation and volumetric density estimation in breast MRI using an atlas-aided fuzzy C-means method

International Nuclear Information System (INIS)

Wu, Shandong; Weinstein, Susan P.; Conant, Emily F.; Kontos, Despina

2013-01-01

Purpose: Breast magnetic resonance imaging (MRI) plays an important role in the clinical management of breast cancer. Studies suggest that the relative amount of fibroglandular (i.e., dense) tissue in the breast as quantified in MR images can be predictive of the risk for developing breast cancer, especially for high-risk women. Automated segmentation of the fibroglandular tissue and volumetric density estimation in breast MRI could therefore be useful for breast cancer risk assessment. Methods: In this work the authors develop and validate a fully automated segmentation algorithm, namely, an atlas-aided fuzzy C-means (FCM-Atlas) method, to estimate the volumetric amount of fibroglandular tissue in breast MRI. The FCM-Atlas is a 2D segmentation method working on a slice-by-slice basis. FCM clustering is first applied to the intensity space of each 2D MR slice to produce an initial voxelwise likelihood map of fibroglandular tissue. Then a prior learned fibroglandular tissue likelihood atlas is incorporated to refine the initial FCM likelihood map to achieve enhanced segmentation, from which the absolute volume of the fibroglandular tissue (|FGT|) and the relative amount (i.e., percentage) of the |FGT| relative to the whole breast volume (FGT%) are computed. The authors' method is evaluated by a representative dataset of 60 3D bilateral breast MRI scans (120 breasts) that span the full breast density range of the American College of Radiology Breast Imaging Reporting and Data System. The automated segmentation is compared to manual segmentation obtained by two experienced breast imaging radiologists. Segmentation performance is assessed by linear regression, Pearson's correlation coefficients, Student's pairedt-test, and Dice's similarity coefficients (DSC). Results: The inter-reader correlation is 0.97 for FGT% and 0.95 for |FGT|. When compared to the average of the two readers’ manual segmentation, the proposed FCM-Atlas method achieves a correlation ofr = 0

Spectral embedding based active contour (SEAC): application to breast lesion segmentation on DCE-MRI

Science.gov (United States)

Agner, Shannon C.; Xu, Jun; Rosen, Mark; Karthigeyan, Sudha; Englander, Sarah; Madabhushi, Anant

2011-03-01

Spectral embedding (SE), a graph-based manifold learning method, has previously been shown to be useful in high dimensional data classification. In this work, we present a novel SE based active contour (SEAC) segmentation scheme and demonstrate its applications in lesion segmentation on breast dynamic contrast enhance magnetic resonance imaging (DCE-MRI). In this work, we employ SE on DCE-MRI on a per voxel basis to embed the high dimensional time series intensity vector into a reduced dimensional space, where the reduced embedding space is characterized by the principal eigenvectors. The orthogonal eigenvector-based data representation allows for computation of strong tensor gradients in the spectrally embedded space and also yields improved region statistics that serve as optimal stopping criteria for SEAC. We demonstrate both analytically and empirically that the tensor gradients in the spectrally embedded space are stronger than the corresponding gradients in the original grayscale intensity space. On a total of 50 breast DCE-MRI studies, SEAC yielded a mean absolute difference (MAD) of 3.2+/-2.1 pixels and mean Dice similarity coefficient (DSC) of 0.74+/-0.13 compared to manual ground truth segmentation. An active contour in conjunction with fuzzy c-means (FCM+AC), a commonly used segmentation method for breast DCE-MRI, produced a corresponding MAD of 7.2+/-7.4 pixels and mean DSC of 0.58+/-0.32. In conjunction with a set of 6 quantitative morphological features automatically extracted from the SEAC derived lesion boundary, a support vector machine (SVM) classifier yielded an area under the curve (AUC) of 0.73, for discriminating between 10 benign and 30 malignant lesions; the corresponding SVM classifier with the FCM+AC derived morphological features yielded an AUC of 0.65.

Rupture of the Distal Biceps Tendon Combined with a Supinator Muscle Tear in a 51-Year-Old Woman: A Case Report

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Samir Nayyar

2011-01-01

Full Text Available Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique.

Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3 T compared to FDG-PET-CT

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Schmidt, Gerwin P. [Institute of Clinical Radiology, University Hospitals Munich-Grosshadern, Marchioninistr. 15, 81377 Munich (Germany)], E-mail: gerwin.schmidt@med.uni-muenchen.de; Baur-Melnyk, Andrea [Institute of Clinical Radiology, University Hospitals Munich-Grosshadern, Marchioninistr. 15, 81377 Munich (Germany); Haug, Alexander [Department of Nuclear Medicine, University Hospitals Munich-Grosshadern, 81377 Munich (Germany); Heinemann, Volker [Department of Internal Medicine III, University Hospitals Munich-Grosshadern, 81377 Munich (Germany); Bauerfeind, Ingo [Department of Obstetrics and Gynecology, University Hospitals Munich-Grosshadern, 81377 Munich (Germany); Reiser, Maximilian F. [Institute of Clinical Radiology, University Hospitals Munich-Grosshadern, Marchioninistr. 15, 81377 Munich (Germany); Schoenberg, Stefan O. [Institute of Clinical Radiology University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg (Germany)

2008-01-15

Purpose: To compare the diagnostic accuracy for the detection of tumor recurrence in breast cancer patients using whole-body-MRI (WB-MRI) at 1.5 or 3 T compared to FDG-PET-CT. Materials and methods: Thirty-three female patients with breast cancer and suspicion of recurrence underwent FDG-PET-CT and WB-MRI. Coronal T1w-TSE- and STIR-sequences, HASTE-imaging of the lungs, contrast-enhanced T1w- and T2w-TSE-sequences of the liver, brain and abdomen were performed, using a WB-MRI-scanner at 1.5 (n = 23) or 3 T (n = 10). Presence of local recurrence, lymph node involvement and distant metastatic disease was assessed using clinical and radiological follow-up as a standard of reference. Results: Tumor recurrence was found in 20 of 33 patients. Overall 186 malignant foci were detected with WB-MRI and PET-CT. Both modalities revealed two recurrent tumors of the breast. PET-CT detected more lymph node metastases (n = 21) than WB-MRI (n = 16). WB-MRI was more precise in the detection of distant metastases (n = 154 versus n = 147). Sensitivity was 93% (172/186) and 91% (170/186) for WB-MRI and PET-CT, specificity was 86% (66/77) and 90% (69/77), respectively. Examination times for WB-MRI at 1.5 and 3 T were 51 and 43 min, respectively, examination time for PET-CT was 103 min. Conclusion: WB-MRI and PET-CT are useful for the detection of tumor recurrence in the follow-up of breast cancer. WB-MRI is highly sensitive to distant metastatic disease. PET-CT is more sensitive in detecting lymph node involvement. Tumor screening with WB-MRI is feasible at 1.5 and 3 T, scan time is further reduced at 3 T with identical resolution.

Reliability of isometric subtalar pronator and supinator strength testing.

Science.gov (United States)

Hagen, Marco; Lahner, Matthias; Winhuysen, Martin; Maiwald, Christian

2015-01-01

Due to the specific anatomy of the subtalar joint with its oblique axis, isometric pronator and supinator strength is not well documented. The purpose of this study was to determine intra- and between-session reliability of pronator and supinator strength and lower leg muscle activity measurements during maximum voluntary isometric contractions (MVIC). Pronator and supinator peak torques (PT), with and without supplementary visual muscle strength biofeedback (FB), and muscular activities of peroneus longus (PL) and tibialis anterior (TA) were assessed twice 3 days apart by the same examiner in 21 healthy young male adults (mean age: 27.6 years; SD = 3.9). Limits of agreement (LoA) and minimum detectable change (MDC) were evaluated. By applying FB, reliability of both pronator and supinator PT was improved: LoA were reduced from 32% to 26% and from 20% to 18% and MDC from 20% to 15% and from 16% to 12% in supinator and pronator PT, respectively. Learning effects in pronator and supinator PT (p isometric subtalar pronator and supinator strength testing is reliable in healthy subjects. LoA of 18% and 26% have to be exceeded for pronator and supinator PT, respectively, to detect relevant effects in repeated measures.

Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI.

Science.gov (United States)

Song, Sung Eun; Cho, Nariya; Han, Wonshik

2017-12-01

To evaluate whether the post-clip placement MRI following second-look ultrasound (US)-guided core biopsy is useful to confirm the adequate sampling of suspicious lesions identified on breast MRI. Between 2014 and 2016, 31 consecutive women with 34 suspicious lesions that had not been identified on previous mammography or US were detected using MRI. Among them, 26 women with 29 lesions (mean size 1.5 cm, range 0.5-5.8 cm) found by second-look US underwent US-guided biopsy, subsequent clip insertion and post-clip placement MRI. Five women with five lesions that were not found by second-look US underwent MRI-guided biopsy. The technical success rate and lesion characteristics were described. The technical success rate was 96.6% (28/29). One failure case was a benign, 1.1-cm non-mass enhancement. Of the 28 success cases, 23 (82.1%) were masses and 5 (17.9%) were non-mass enhancements; 17 (60.7%) were benign, 4 (14.3%) were high-risk and 7 (25.0%) were malignant lesions. The technical success rate was 100% (28/28) for masses and 83.3% (5/6) for non-mass enhancements. Post-clip placement MRI following US-guided biopsy is useful in confirming the adequate sampling of lesions identified on MRI. This method could be an alternative to MRI-guided biopsy for lesions visible on US. • Post-clip MRI is useful for confirming adequate sampling of US-guided biopsy. • Post-clip MRI following US-guided biopsy revealed a 96.6 % technical success rate. • One technical failure case was a benign, 1.1-cm non-mass enhancement. • The technical success rate of US-guided biopsy for non-mass enhancements was 83.3 %.

Whole-body MRI in preoperative diagnostics of breast cancer. A comparison with staging methods according to the S 3 guidelines

International Nuclear Information System (INIS)

Hausmann, D.; Schoenberg, S.O.; Neff, K.W.; Dinter, D.J.; Kern, C.; Schroeder, M.T.; Suetterlin, M.

2011-01-01

Purpose: The German Society of Senology (step-3 guidelines for the early recognition of breast cancer in Germany) recommends whole-body staging including chest X-ray, ultrasound of the liver and bone scintigraphy before systemic therapy in patients with breast cancer. The performance of these three examinations is time-consuming and involves radiation exposure. Whole-body MR imaging (WB-MRI) allows staging in a single examination without radiation exposure. The purpose of this study was to compare the diagnostic accuracy of WB-MRI with staging according to the guidelines. Materials and Methods: During 04/07 and 06/09, the initial staging in 51 patients (56 ± 12 yrs) with breast cancer (24 patients with lymph node metastases) was performed according to the S 3-guidelines. Additionally, all patients underwent contrast-enhanced WB-MRI (1.5-Tesla-Magnetom Avanto, Siemens, Erlangen). The findings of the different modalities were compared after correlation of the lesions by follow-up. The detection of suspicious findings and the accuracy of prediction of malignancy of the detected lesions were evaluated. Results: Overall, 14 metastases were detected in 4 of 51 patients after completion of the follow-up. By means of WB-MRI, all 14 metastases could be detected, while just 4 of these metastases were identified by the conventional methods. Conclusion: The detection of distant metastases has an important impact on patient management. In this study WB-MRI in breast cancer staging has shown promising results in regard to possible clinical implementation as a matter of routine staging. (orig.)

Breast imaging reporting and data system (BI-RADS) lexicon for breast MRI: Interobserver variability in the description and assignment of BI-RADS category

International Nuclear Information System (INIS)

El Khoury, Mona; Lalonde, Lucie; David, Julie; Labelle, Maude; Mesurolle, Benoit; Trop, Isabelle

2015-01-01

Highlights: • The use of BI-RADS lexicon in interpreting breast MRI examinations is beneficial. • Our study shows: (a) moderate to substantial agreement between observers and (b) better agreement in interpreting mass than non-mass enhancement (NME). • Careful analysis of the NME should be done to help detect cancer as early as possible. - Abstract: Purpose: To retrospectively evaluate interobserver variability between breast radiologists when describing abnormal enhancement on breast MR examinations and assigning a BI-RADS category using the Breast Imaging Reporting and Data System (BI-RADS) terminology. Materials and methods: Five breast radiologists blinded to patients’ medical history and pathologic results retrospectively and independently reviewed 257 abnormal areas of enhancement on breast MRI performed in 173 women. Each radiologist described the focal enhancement using BI-RADS terminology and assigned a final BI-RADS category. Krippendorff's α coefficient of agreement was used to asses interobserver variability. Results: All radiologists agreed on the morphology of enhancement in 183/257 (71%) lesions, yielding a substantial agreement (Krippendorff's α = 0.71). Moderate agreement was obtained for mass descriptors – shape, margins and internal enhancement – (α = 0.55, 0.51 and 0.45 respectively) and NME (non-mass enhancement) descriptors – distribution and internal enhancement – (α = 0.54 and 0.43). Overall substantial agreement was obtained for BI-RADS category assignment (α = 0.71). It was however only moderate (α = 0.38) for NME compared to mass (α = 0.80). Conclusion: Our study shows good agreement in describing mass and NME on a breast MR examination but a better agreement in predicting malignancy for mass than NME

Breast imaging reporting and data system (BI-RADS) lexicon for breast MRI: Interobserver variability in the description and assignment of BI-RADS category

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El Khoury, Mona, E-mail: monelkhoury@gmail.com [Centre Hospitalier Universitaire de Montréal, Breast Centre, Radiology Department, 3840 Rue Saint Urbain, Montréal, QC H2W1T8 (Canada); Lalonde, Lucie; David, Julie; Labelle, Maude [Centre Hospitalier Universitaire de Montréal, Breast Centre, Radiology Department, 3840 Rue Saint Urbain, Montréal, QC H2W1T8 (Canada); Mesurolle, Benoit [Centre Hospitalier Universitaire de McGill, Cedar Breast Centre, Radiology Department, 687 Pine Avenue West, Montreal, QC H3A1A1 (Canada); Trop, Isabelle [Centre Hospitalier Universitaire de Montréal, Breast Centre, Radiology Department, 3840 Rue Saint Urbain, Montréal, QC H2W1T8 (Canada)

2015-01-15

Highlights: • The use of BI-RADS lexicon in interpreting breast MRI examinations is beneficial. • Our study shows: (a) moderate to substantial agreement between observers and (b) better agreement in interpreting mass than non-mass enhancement (NME). • Careful analysis of the NME should be done to help detect cancer as early as possible. - Abstract: Purpose: To retrospectively evaluate interobserver variability between breast radiologists when describing abnormal enhancement on breast MR examinations and assigning a BI-RADS category using the Breast Imaging Reporting and Data System (BI-RADS) terminology. Materials and methods: Five breast radiologists blinded to patients’ medical history and pathologic results retrospectively and independently reviewed 257 abnormal areas of enhancement on breast MRI performed in 173 women. Each radiologist described the focal enhancement using BI-RADS terminology and assigned a final BI-RADS category. Krippendorff's α coefficient of agreement was used to asses interobserver variability. Results: All radiologists agreed on the morphology of enhancement in 183/257 (71%) lesions, yielding a substantial agreement (Krippendorff's α = 0.71). Moderate agreement was obtained for mass descriptors – shape, margins and internal enhancement – (α = 0.55, 0.51 and 0.45 respectively) and NME (non-mass enhancement) descriptors – distribution and internal enhancement – (α = 0.54 and 0.43). Overall substantial agreement was obtained for BI-RADS category assignment (α = 0.71). It was however only moderate (α = 0.38) for NME compared to mass (α = 0.80). Conclusion: Our study shows good agreement in describing mass and NME on a breast MR examination but a better agreement in predicting malignancy for mass than NME.

A new bias field correction method combining N3 and FCM for improved segmentation of breast density on MRI.

Science.gov (United States)

Lin, Muqing; Chan, Siwa; Chen, Jeon-Hor; Chang, Daniel; Nie, Ke; Chen, Shih-Ting; Lin, Cheng-Ju; Shih, Tzu-Ching; Nalcioglu, Orhan; Su, Min-Ying

2011-01-01

Quantitative breast density is known as a strong risk factor associated with the development of breast cancer. Measurement of breast density based on three-dimensional breast MRI may provide very useful information. One important step for quantitative analysis of breast density on MRI is the correction of field inhomogeneity to allow an accurate segmentation of the fibroglandular tissue (dense tissue). A new bias field correction method by combining the nonparametric nonuniformity normalization (N3) algorithm and fuzzy-C-means (FCM)-based inhomogeneity correction algorithm is developed in this work. The analysis is performed on non-fat-sat T1-weighted images acquired using a 1.5 T MRI scanner. A total of 60 breasts from 30 healthy volunteers was analyzed. N3 is known as a robust correction method, but it cannot correct a strong bias field on a large area. FCM-based algorithm can correct the bias field on a large area, but it may change the tissue contrast and affect the segmentation quality. The proposed algorithm applies N3 first, followed by FCM, and then the generated bias field is smoothed using Gaussian kernal and B-spline surface fitting to minimize the problem of mistakenly changed tissue contrast. The segmentation results based on the N3+FCM corrected images were compared to the N3 and FCM alone corrected images and another method, coherent local intensity clustering (CLIC), corrected images. The segmentation quality based on different correction methods were evaluated by a radiologist and ranked. The authors demonstrated that the iterative N3+FCM correction method brightens the signal intensity of fatty tissues and that separates the histogram peaks between the fibroglandular and fatty tissues to allow an accurate segmentation between them. In the first reading session, the radiologist found (N3+FCM > N3 > FCM) ranking in 17 breasts, (N3+FCM > N3 = FCM) ranking in 7 breasts, (N3+FCM = N3 > FCM) in 32 breasts, (N3+FCM = N3 = FCM) in 2 breasts, and (N3 > N3

Longitudinal, intermodality registration of quantitative breast PET and MRI data acquired before and during neoadjuvant chemotherapy: Preliminary results

International Nuclear Information System (INIS)

Atuegwu, Nkiruka C.; Williams, Jason M.; Li, Xia; Arlinghaus, Lori R.; Abramson, Richard G.; Chakravarthy, A. Bapsi; Abramson, Vandana G.; Yankeelov, Thomas E.

2014-01-01

Purpose: The authors propose a method whereby serially acquired DCE-MRI, DW-MRI, and FDG-PET breast data sets can be spatially and temporally coregistered to enable the comparison of changes in parameter maps at the voxel level. Methods: First, the authors aligned the PET and MR images at each time point rigidly and nonrigidly. To register the MR images longitudinally, the authors extended a nonrigid registration algorithm by including a tumor volume-preserving constraint in the cost function. After the PET images were aligned to the MR images at each time point, the authors then used the transformation obtained from the longitudinal registration of the MRI volumes to register the PET images longitudinally. The authors tested this approach on ten breast cancer patients by calculating a modified Dice similarity of tumor size between the PET and MR images as well as the bending energy and changes in the tumor volume after the application of the registration algorithm. Results: The median of the modified Dice in the registered PET and DCE-MRI data was 0.92. For the longitudinal registration, the median tumor volume change was −0.03% for the constrained algorithm, compared to −32.16% for the unconstrained registration algorithms (p = 8 × 10 −6 ). The medians of the bending energy were 0.0092 and 0.0001 for the unconstrained and constrained algorithms, respectively (p = 2.84 × 10 −7 ). Conclusions: The results indicate that the proposed method can accurately spatially align DCE-MRI, DW-MRI, and FDG-PET breast images acquired at different time points during therapy while preventing the tumor from being substantially distorted or compressed

MRI-Guided Diffuse Optical Spectroscopy of Malignant and Benign Breast Lesions

Directory of Open Access Journals (Sweden)

Vasilis Ntziachristos

2002-01-01

Full Text Available We present the clinical implementation of a novel hybrid system that combines magnetic resonance imaging (MRI and near-infrared (NIR optical measurements for the noninvasive study of breast cancer in vivo. Fourteen patients were studied with a MR-NIR prototype imager and spectrometer. A diffuse optical tomographic scheme employed the MR images as a priori information to implement an image-guided NIR localized spectroscopic scheme. All patients who entered the study also underwent gadolinium-enhanced MRI and biopsy so that the optical findings were crossvalidated with MR readings and histopathology. The technique quantified the oxy-and deoxyhemoglobin of five malignant and nine benign breast lesions in vivo. Breast cancers were found with decreased oxygen saturation and higher blood concentration than most benign lesions. The average hemoglobin concentration ([H] of cancers was 0.130±0.100 mM, and the average hemoglobin saturation (Y was 60±9% compared to [H]=0.018±0.005 mM and Y=69±6% of background tissue. Fibroadenomas exhibited high hemoglobin concentration [H]=0.060±0.010 mM and mild decrease in oxygen saturation Y=67±2%. Cysts and other normal lesions were easily differentiated based on intrinsic contrast information. This novel optical technology can be a significant add-on in MR examinations and can be used to characterize functional parameters of cancers with diagnostic and treatment prognosis potential. It is foreseen that the technique can play a major role in functional activation studies of brain and muscle as well.

Interobserver variability in identification of breast tumors in MRI and its implications for prognostic biomarkers and radiogenomics

Energy Technology Data Exchange (ETDEWEB)

Saha, Ashirbani, E-mail: as698@duke.edu; Grimm, Lars J., E-mail: lars.grimm@duke.edu; Harowicz, Michael, E-mail: michael.harowicz@duke.edu; Ghate, Sujata V., E-mail: sujata.ghate@duke.edu; Kim, Connie, E-mail: connie.kim@duke.edu; Walsh, Ruth, E-mail: ruth.walsh@duke.edu; Mazurowski, Maciej A., E-mail: maciej.mazurowski@duke.edu [Department of Radiology, Duke University Medical Center, 2424 Erwin Road, Suite 302, Durham, North Carolina 27705 (United States)

2016-08-15

Purpose: To assess the interobserver variability of readers when outlining breast tumors in MRI, study the reasons behind the variability, and quantify the effect of the variability on algorithmic imaging features extracted from breast MRI. Methods: Four readers annotated breast tumors from the MRI examinations of 50 patients from one institution using a bounding box to indicate a tumor. All of the annotated tumors were biopsy proven cancers. The similarity of bounding boxes was analyzed using Dice coefficients. An automatic tumor segmentation algorithm was used to segment tumors from the readers’ annotations. The segmented tumors were then compared between readers using Dice coefficients as the similarity metric. Cases showing high interobserver variability (average Dice coefficient <0.8) after segmentation were analyzed by a panel of radiologists to identify the reasons causing the low level of agreement. Furthermore, an imaging feature, quantifying tumor and breast tissue enhancement dynamics, was extracted from each segmented tumor for a patient. Pearson’s correlation coefficients were computed between the features for each pair of readers to assess the effect of the annotation on the feature values. Finally, the authors quantified the extent of variation in feature values caused by each of the individual reasons for low agreement. Results: The average agreement between readers in terms of the overlap (Dice coefficient) of the bounding box was 0.60. Automatic segmentation of tumor improved the average Dice coefficient for 92% of the cases to the average value of 0.77. The mean agreement between readers expressed by the correlation coefficient for the imaging feature was 0.96. Conclusions: There is a moderate variability between readers when identifying the rectangular outline of breast tumors on MRI. This variability is alleviated by the automatic segmentation of the tumors. Furthermore, the moderate interobserver variability in terms of the bounding box

Usefulness of 3D-VIBE method in breast dynamic MRI. Imaging parameters and contrasting effects

International Nuclear Information System (INIS)

Uchikoshi, Masato; Ueda, Takashi; Nishiki, Shigeo; Satou, Kouichi; Wada, Akihiko; Imaoka, Izumi; Matsuo, Michimasa

2003-01-01

MR imaging (MRI) has been reported to be a useful modality to characterize breast tumors and to evaluate disease extent. Contrast-enhanced dynamic MRI, in particular, allows breast lesions to be characterized with high sensitivity and specificity. Our study was designed to develop three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) techniques for the evaluation of breast tumors. First, agarose/Gd-DTPA phantoms with various concentrations of Gd-DTPA were imaged using 3D-VIBE and turbo spin echo (TSE). Second, one of the phantoms was imaged with 3D-VIBE using different flip angles. Finally, water excitation (WE) and a chemical shift-selective (CHESS) pulse were applied to the images. Each image was analyzed for signal intensity, signal-to-noise ratio (1.25*Ms/Mb) (SNR), and contrast ratio [(Ms1-Ms2)/{(Ms1+Ms2)/2}]. The results showed that 3D-VIBE provided better contrast ratios with a linear fit than TSE, although 3D-VIBE showed a lower SNR. To reach the best contrast ratio, the optimized flip angle was found to be 30 deg for contrast-enhanced dynamic study. Both WE and CHESS pulses were reliable for obtaining fat- suppressed images. In conclusion, the 3D-VIBE technique can image the entire breast area with high resolution and provide better contrast than TSE. Our phantom study suggests that optimized 3D-VIBE may be useful for the assessment of breast tumors. (author)

Isometric elbow extensors strength in supine- and prone-lying positions.

Science.gov (United States)

Abdelzaher, Ibrahim E; Ababneh, Anas F; Alzyoud, Jehad M

2013-01-01

The purpose of this study was to compare isometric strength of elbow extensors measured in supine- and prone-lying positions at elbow flexion angles of 45 and 90 degrees. Twenty-two male subjects under single-blind procedures participated in the study. Each subject participated in both supine-lying and prone-lying measuring protocols. Calibrated cable tensiometer was used to measure isometric strength of the right elbow extensors and a biofeedback electromyography was used to assure no substitution movements from shoulder girdle muscles. The mean values of isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees were 11.1  ±  4.2 kg and 13.1  ±  4.6 kg, while those measured from prone-lying position were 9.9  ±  3.6 kg and 12  ±  4.2 kg, respectively. There is statistical significant difference between the isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees compared to that measured from prone-lying position (p  isometric strength of elbow extensors since supine-lying starting position is better than prone-lying starting position.

Correlation between E-cadherin and p120 expression in invasive ductal breast cancer with a lobular component and MRI findings.

Science.gov (United States)

El Sharouni, Mary-Ann; Postma, Emily L; van Diest, Paul J

2017-12-01

Invasive breast cancer comprises a spectrum of histological changes with purely lobular cancer on one side and purely ductal cancer on the other, with many mixed lesions in between. In a previous study, we showed that in patients with any percentage lobular component at core needle biopsy, preoperative MRI leads to the detection of clinically relevant additional findings in a substantial percentage of patients, irrespective of the percentage of the lobular component. Detection of a small lobular component may however not be reproducible among pathologists. Loss of membrane expression of E-cadherin or p120 is useful biomarkers of ILC and may therefore support a more objective diagnosis. All patients diagnosed with breast cancer containing a lobular component of any percentage between January 2008 and October 2012 were prospectively offered preoperative MRI. Clinically relevant additional findings on MRI were verified by pathology evaluation. Expression patterns of E-cadherin and p120 were evaluated by immunohistochemistry on the core needle biopsy. MRI was performed in 109 patients. The percentage of lobular component was significantly increased in cases with aberrant E-cadherin or p120 expression (both p = lobular component in the core needle of their breast cancer.

Quantitative DCE-MRI for prediction of pathological complete response following neoadjuvant treatment for locally advanced breast cancer: the impact of breast cancer subtypes on the diagnostic accuracy

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Drisis, Stylianos; Stathopoulos, Konstantinos; Chao, Shih-Li; Lemort, Marc [Institute Jules Bordet, Radiology Department, Brussels (Belgium); Metens, Thierry [Erasme University Hospital, Radiology Department, Brussels (Belgium); Ignatiadis, Michael [Institute Jules Bordet, Oncology Department, Brussels (Belgium)

2016-05-15

To assess whether DCE-MRI pharmacokinetic (PK) parameters obtained before and during chemotherapy can predict pathological complete response (pCR) differently for different breast cancer groups. Eighty-four patients who received neoadjuvant chemotherapy for locally advanced breast cancer were retrospectively included. All patients underwent two DCE-MRI examinations, one before (EX1) and one during treatment (EX2). Tumours were classified into different breast cancer groups, namely triple negative (TNBC), HER2+ and ER+/HER2-, and compared with the whole population (WP). PK parameters Ktrans and Ve were extracted using a two-compartment Tofts model. At EX1, Ktrans predicted pCR for WP and TNBC. At EX2, maximum diameter (Dmax) predicted pCR for WP and ER+/HER2-. Both PK parameters predicted pCR in WP and TNBC and only Ktrans for the HER2+. pCR was predicted from relative difference (EX1 - EX2)/EX1 of Dmax and both PK parameters in the WP group and only for Ve in the TNBC group. No PK parameter could predict response for ER+/HER-. ROC comparison between WP and breast cancer groups showed higher but not statistically significant values for TNBC for the prediction of pCR Quantitative DCE-MRI can better predict pCR after neoadjuvant treatment for TNBC but not for the ER+/HER2- group. (orig.)

Comparison of imaging diagnosis of pyogenic abscess and inflammatory cancer in the breast: focused on MRI

International Nuclear Information System (INIS)

Ko, Mi Gyoung; Chung, Soo Young; Yang, Ik; Park, Jong Ho; Lee, Kyung Won; Lee, Yul; Chung, Bong Wha; Kim, Jong Hyun

1999-01-01

To compare the radiologic findings of pyogenic abscess(PA) and inflammatory cancer(IC) of the breast, as seen on mammograms, US, and MR images and to evaluate the usefulness of the differential diagnostic findings of MRI for differentiation of PA and IC of the breast. We retrospectively analyzed the mammographic, US and MR findings of nine histopathologically proven cases of PA and four cases of IC of the breast . Parenchymal density, mass density, skin thickening and calcification were evaluated by mammography, and the extent of lesion and its morphologic characteristics and changes of dermal lymphatics by US and MRI. The latter was also used to analyse signal intensity and enhancement pattern. Mammographic findings for both lesions were non-specific. US showed that the pyogenic abscess was a hypoechoic and anechoic complex lesion with posterior acoustic enhancement, while inflammatory cancer was a speculated lesion with a heterogeneous hypoechoic echotexture. On 3D-GRE dynamic enhanced MRI, PA was shown in six cases(66.7 %) to be a lesion with superficial periareolar involvement, in contrast to the deep parenchymal spread seen in all cases of IC. A central non-enhanced portion with an irregular thick peripheral enhanced rim was seen in eight cases of PA(88.9 %), and in all cases of IC an inhomogeneously enhanced spiculated lesion in parenchyma and a diffusely enhanced dermal and subcutaneous layer was apparent. An MRI time-intensity curve showed that the enhancement pattern was slow in five cases of PA(55.6 %) and irregular in four(44.4 %), while for IC it was rapid in three cases(33.3 %) and irregular in one(11.1 %). As compared with mammography and US, 3D-GRE dynamic MRI was a useful method for the differential diagnosis of PA and IC of the breast. The characteristic MR findings of PA were a central non-enhanced portion with an irregularly thick peripheral enhanced rim, located mainly in the superficial periareloar area and spreading into the parenchymal layer

Comparison of imaging diagnosis of pyogenic abscess and inflammatory cancer in the breast: focused on MRI

Energy Technology Data Exchange (ETDEWEB)

Ko, Mi Gyoung; Chung, Soo Young; Yang, Ik; Park, Jong Ho; Lee, Kyung Won; Lee, Yul; Chung, Bong Wha; Kim, Jong Hyun [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

1999-09-01

To compare the radiologic findings of pyogenic abscess(PA) and inflammatory cancer(IC) of the breast, as seen on mammograms, US, and MR images and to evaluate the usefulness of the differential diagnostic findings of MRI for differentiation of PA and IC of the breast. We retrospectively analyzed the mammographic, US and MR findings of nine histopathologically proven cases of PA and four cases of IC of the breast . Parenchymal density, mass density, skin thickening and calcification were evaluated by mammography, and the extent of lesion and its morphologic characteristics and changes of dermal lymphatics by US and MRI. The latter was also used to analyse signal intensity and enhancement pattern. Mammographic findings for both lesions were non-specific. US showed that the pyogenic abscess was a hypoechoic and anechoic complex lesion with posterior acoustic enhancement, while inflammatory cancer was a speculated lesion with a heterogeneous hypoechoic echotexture. On 3D-GRE dynamic enhanced MRI, PA was shown in six cases(66.7 %) to be a lesion with superficial periareolar involvement, in contrast to the deep parenchymal spread seen in all cases of IC. A central non-enhanced portion with an irregular thick peripheral enhanced rim was seen in eight cases of PA(88.9 %), and in all cases of IC an inhomogeneously enhanced spiculated lesion in parenchyma and a diffusely enhanced dermal and subcutaneous layer was apparent. An MRI time-intensity curve showed that the enhancement pattern was slow in five cases of PA(55.6 %) and irregular in four(44.4 %), while for IC it was rapid in three cases(33.3 %) and irregular in one(11.1 %). As compared with mammography and US, 3D-GRE dynamic MRI was a useful method for the differential diagnosis of PA and IC of the breast. The characteristic MR findings of PA were a central non-enhanced portion with an irregularly thick peripheral enhanced rim, located mainly in the superficial periareloar area and spreading into the parenchymal layer

Diagnostic accuracy of {sup 18}F-FDG PET/CT compared with that of contrast-enhanced MRI of the breast at 3 T

Energy Technology Data Exchange (ETDEWEB)

Magometschnigg, Heinrich F.; Baltzer, Pascal A.; Fueger, Barbara; Helbich, Thomas H.; Weber, Michael [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Vienna (Austria); Karanikas, Georgios [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna (Austria); Dubsky, Peter [Medical University of Vienna, Department of Surgery, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Department of Pathology, Vienna (Austria); Pinker, Katja [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Vienna (Austria); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York (United States)

2015-10-15

To compare the diagnostic accuracy of prone {sup 18}F-FDG PET/CT with that of contrast-enhanced MRI (CE-MRI) at 3 T in suspicious breast lesions. To evaluate the influence of tumour size on diagnostic accuracy and the use of maximum standardized uptake value (SUV{sub MAX}) thresholds to differentiate malignant from benign breast lesions. A total of 172 consecutive patients with an imaging abnormality were included in this IRB-approved prospective study. All patients underwent {sup 18}F-FDG PET/CT and CE-MRI of the breast at 3 T in the prone position. Two reader teams independently evaluated the likelihood of malignancy as determined by {sup 18}F-FDG PET/CT and CE-MRI independently. {sup 18}F-FDG PET/CT data were qualitatively evaluated by visual interpretation. Quantitative assessment was performed by calculation of SUV{sub MAX}. Sensitivity, specificity, diagnostic accuracy, area under the curve and interreader agreement were calculated for all lesions and for lesions <10 mm. Histopathology was used as the standard of reference. There were 132 malignant and 40 benign lesions; 23 lesions (13.4 %) were <10 mm. Both {sup 18}F-FDG PET/CT and CE-MRI achieved an overall diagnostic accuracy of 93 %. There were no significant differences in sensitivity (p = 0.125), specificity (p = 0.344) or diagnostic accuracy (p = 1). For lesions <10 mm, diagnostic accuracy deteriorated to 91 % with both {sup 18}F-FDG PET/CT and CE-MRI. Although no significant difference was found for lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than {sup 18}F-FDG PET/CT. Interreader agreement was excellent (κ = 0.85 and κ = 0.92). SUV{sub MAX} threshold was not helpful in differentiating benign from malignant lesions. {sup 18}F-FDG PET/CT and CE-MRI at 3 T showed equal diagnostic accuracies in breast cancer diagnosis. For lesions <10 mm, diagnostic accuracy deteriorated, but was equal for {sup 18}F-FDG PET/CT and CE-MRI at 3 T. For lesions <10 mm, CE-MRI at 3 T seemed

How well tolerated is supine percutaneous nephrolithotomy?

NARCIS (Netherlands)

Baard, Joyce; Kamphuis, Guido M.; Westendarp, Matias; de La Rosette, Jean J. M. C. H.

2014-01-01

Supine percutaneous nephrolithotomy (PCNL) has been described in 1988 and several modifications followed since. Despite claimed benefits, supine PCNL is still neglected by the majority of urologists. Lack of experience and the fear of complications are possible explanations for the resistance to

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer.

Science.gov (United States)

Liu, Qian; Liu, Yinhua; Xu, Ling; Duan, Xuening; Li, Ting; Qin, Naishan; Kang, Hua; Jiang, Hongchuan; Yang, Deqi; Qu, Xiang; Jiang, Zefei; Yu, Chengze

2014-01-01

This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer. The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group. The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P surgery were 100% and 88.54%, respectively. There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.

Epithelioid Myofibroblastoma in an Old-Male Breast: A Case Report with MRI Findings

Directory of Open Access Journals (Sweden)

Seyma Yildiz

2015-01-01

Full Text Available Myofibroblastoma of the breast (MFB is a very rare benign stromal tumor. In recent years, increase in mammographic screenings has resulted in increased diagnosis of MFB. Most cases are old males and postmenopausal women. MFB may be confused as malignant, clinically, morphologically, or by imaging. Immunohistochemistry is essential for final diagnosis in these cases. We report a case of a pathologically diagnosed MFB in an 80-year-old male patient who had coexisting prostate cancer and describe its imaging characteristics, especially magnetic resonance imaging (MRI. In this paper, histopathological and MRI findings of the MFB were discussed.

PIP breast implants: rupture rate and correlation with breast cancer.

Science.gov (United States)

Moschetta, M; Telegrafo, M; Cornacchia, I; Vincenti, L; Ranieri, V; Cirili, A; Rella, L; Stabile Ianora, A A; Angelelli, G

2014-01-01

To evaluate the incidence of Poly Implant Prosthése (PIP) rupture as assessed by magnetic resonance imaging (MRI), the prevalence of the detected signs and the potential correlation with breast carcinoma. 67 patients with silicone breast implants and clinical indications for breast MRI were evaluated for a total of 125 implants: 40 (32%) PIP in 21 patients and 85 non-PIP in 46 patients (68%), the latest considered as control group. A 1.5-T MR imaging device was used in order to assess implant integrity with dedicated sequences and in 6 cases a dynamic study was performed for characterizing breast lesions. Two radiologists with more than 5 years' experience in the field of MRI evaluated in consensus all MR images searching for the presence of clear signs of intra or extra-capsular implant rupture. 20/40 (50%) PIP implants presented signs of intra-capsular rupture: linguine sign in 20 cases (100%), tear-drop sign in 6 (30%). In 12/20 cases (60%), MRI signs of extra-capsular rupture were detected. In the control group, an intra-capsular rupture was diagnosed in 12/85 cases (14%) associated with extra-capsular one in 5/12 cases (42%). Among the six cases with suspected breast lesions, in 2/21 patients with PIP implants (10%) a breast carcinoma was diagnosed (mucinous carcinoma, n=1; invasive ductal carcinoma, n=1). In 4/46 patients (9%) with non-PIP implants, an invasive ductal carcinoma was diagnosed. The rupture rate of PIP breast implants is significantly higher than non-PIP (50% vs 14%). MRI represents the most accurate imaging tool for evaluating breast prostheses and the linguine sign is the most common MRI sign to be searched. The incidence of breast carcinoma does not significantly differ between the PIP and non-PIP implants and a direct correlation with breast cancer can not been demonstrated.

MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ

International Nuclear Information System (INIS)

Kim, Do Youn; Moon, Woo Kyung; Cho, Nariya

2007-01-01

The aim of the study was to compare the accuracy of magnetic resonance imaging (MRI) and mammography for the detection and assessment of the size of ductal carcinoma in situ (DCIS). The preoperative contrast-enhanced MRI and mammography were analyzed in respect of the detection and assessment of the size of DCIS in 72 patients (age range: 30 67 years, mean age: 47 years). The MRI and mammographic measurements were compared with the histopathologic size with using the Pearson's correlation coefficients and the Mann-Whitney u test. We evaluated whether the breast density, the tumor nuclear grade, the presence of comedo necrosis and microinvasion influenced the MRI and mammographic size estimates by using the chi-square test. Of the 72 DCIS lesions, 68 (94%) were detected by MRI and 62 (86%) were detected by mammography. Overall, the Pearson's correlation of the size between MRI and histopathology was 0.786 versus 0.633 between mammography and histopathology (p < 0.001). MRI underestimated the size by more than 1 cm (including false negative examination) in 12 patients (17%), was accurate in 52 patients (72%) and overestimated the size by more than 1 cm in eight patients (11%) whereas mammography underestimated the size in 25 patients (35%), was accurate in 31 patients (43%) and overestimated the size in 16 patients (22%). The MRI, but not the mammography, showed significant correlation for the assessment of the size of tumor in noncomedo DCIS (p < 0.001 vs p = 0.060). The assessment of tumor size by MRI was affected by the nuclear grade (p = 0.008) and the presence of comedo necrosis (p = 0.029), but not by the breast density (p 0.747) or microinvasion (p = 0.093). MRI was more accurate for the detection and assessment of the size of DCIS than mammography

Preliminary evaluation of data mining on non-masslike enhancement of breast lesions on MRI

International Nuclear Information System (INIS)

Tan Hongna; Li Ruimin; Wang Peihua; Tang Feng; Mao Jian; Shen Xigang; Qian Min; Gu Yajia; Su Yi; Chen Ying

2009-01-01

Objective: To evaluate the diagnostic values of the breast imaging reporting and data system-MRI (BI-RADS-MRI)description about non-masslike enhancement by data mining. Methods: Fifty- five patients with non-masslike enhancement lesions showed on breast contrast-enhanced MRI were evaluated using two data mining algorithms (Logistic regression and decision tree) and 10-fold cross-validation methods. Results: There were 28 malignant and 27 benign lesions. The most frequent findings of the malignant lesions were clustered ring enhancement and clumped enhancement [12 and 4 lesions, respectively; 84.2% (16/19) in decision trees, partial regression coefficients in Logistic model were 2.128 and 1.723, respectively], whereas homogenous, stippled, reticular internal and linear ductal enhancement were the most frequent findings in benign lesions [4,9,1 and 7 lesions, respectively; 72.4% (21/29) in decision tree, partial regression coefficients in Logistic model were 0.357 (homogenous), 1.861 (stippled) and 18.870(reticular), respectively]. 10-fold cross-validation indicated that decision tree (C5.0) achieved an accuracy of 69.3% with a sensitivity of 66.7% and a specificity of 71.7% in comparison to the Logistic regression model with an accuracy of 57.0%, a sensitivity of 43.3% and a specificity of 71.7%. Conclusions: The diagnosis efficacy of non-masslike enhancement interpretation according to BI-RADS-MRI is not high. It is very important to find more potential features of non-masslike enhancement to improve the diagnosis accuracy. (authors)

Magnetic resonance imaging of the breast: current indications

International Nuclear Information System (INIS)

Lalonde, L.; David, J.; Trop, I.

2005-01-01

Breast magnetic resonance imaging (MRI) plays an increasing role in the management of selecting breast cancer patients. MRI is recognized as the most sensitive modality for the detection of invasive breast cancer. Several valuable clinical applications of MRI have emerged for breast cancer detection and diagnosis from clinical investigations. Breast MRI is helpful for women diagnosed with breast cancer who contemplate breast conserving surgery; it provides valuable information on the extent of the disease. MRI can also help assess for residual invasive cancer in patients who have undergone lumpectomy with positive margins at pathology. It is very reliable in differentiating scar tissue from recurrence at the lumpectomy site. MRI is also reliable in finding a breast cancer in women with axillary nodal metastases and unknown primary tumour. MRI can help to monitor the response to chemotherapy. Breast MRI could be a better screening tool than mammography in women with very high risks of developing breast cancer, such as breast cancer gene carriers and patients treated with chest radiation. Other potential uses of MRI include evaluation of the integrity of silicone breast implants and evaluation of the parenchyma in women with silicone gel implants or free injection of silicone gel. However, like any other technique, breast MRI has some drawbacks, including low-to-moderate specificity, high costs, and variability in technique and interpretation. Radiologists must have a clear understanding of valid indications and selection criteria to use this technique appropriately. (author)

Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

Energy Technology Data Exchange (ETDEWEB)

Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Thompson, Reid F.; Chen Yu; Bernstein, Karen; Kabarriti, Rafi; Skinner, William [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States); Chen, Chin C. [Department of Radiation Oncology, Columbia University Medical Center, New York, New York (United States); Landau, Evan; Miller, Ekeni; Spierer, Marnee; Hong, Linda; Kalnicki, Shalom [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States)

2012-11-15

Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm{sub 3}) (n=97) and small-breasted patients (chest wall separation <25 cm and PTV <1500 cm{sub 3}) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable

Integrated 18F-FDG PET/MRI in breast cancer. Early prediction of response to neoadjuvant chemotherapy

International Nuclear Information System (INIS)

Cho, Nariya; Im, Seock-Ah; Lee, Kyung-Hun; Kim, Tae-Yong; Cheon, Gi Jeong; Park, In-Ae; Kim, Young Seon; Kwon, Bo Ra; Lee, Jung Min; Suh, Hoon Young; Suh, Koung Jin

2018-01-01

To explore whether integrated 18 F-FDG PET/MRI can be used to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Between November 2014 and April 2016, 26 patients with breast cancer who had received NAC and subsequent surgery were prospectively enrolled. Each patient underwent 18 F-FDG PET/MRI examination before and after the first cycle of NAC. Qualitative MRI parameters, including morphological descriptors and the presence of peritumoral oedema were assessed. Quantitatively, PET parameters, including maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis (TLG), and MRI parameters, including washout proportion and signal enhancement ratio (SER), were measured. The performance of the imaging parameters singly and in combination in predicting a pathological incomplete response (non-pCR) was assessed. Of the 26 patients, 7 (26.9%) exhibited a pathological complete response (pCR), and 19 (73.1%) exhibited a non-pCR. No significant differences were found between the pCR and non-pCR groups in the qualitative MRI parameters. The mean percentage reductions in TLG 30% on PET and SER on MRI were significantly greater in the pCR group than in the non-pCR group (TLG 30% -64.8 ± 15.5% vs. -25.4 ± 48.7%, P = 0.005; SER -34.6 ± 19.7% vs. -8.7 ± 29.0%, P = 0.040). The area under the receiver operating characteristic curve for the percentage change in TLG 30% (0.789, 95% CI 0.614 to 0.965) was similar to that for the percentage change in SER (0.789, 95% CI 0.552 to 1.000; P = 1.000). The specificity of TLG 30% in predicting pCR was 100% (7/7) and that of SER was 71.4% (5/7). The sensitivity of TLG 30% in predicting non-pCR was 63.2% (12/19) and that of SER was 84.2% (16/19). When the combined TLG 30% and SER criterion was applied, sensitivity was 100% (19/19), and specificity was 71.4% (5/7). 18 F-FDG PET/MRI can be used to predict non-pCR after the first cycle of NAC in patients with breast cancer

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

Energy Technology Data Exchange (ETDEWEB)

Crystal, Pavel [Mount Sinai Hospital, University Health Network, Division of Breast Imaging, Toronto, ON (Canada); Mount Sinai Hospital, Toronto, ON (Canada); Sadaf, Arifa; Bukhanov, Karina; Helbich, Thomas H. [Mount Sinai Hospital, University Health Network, Division of Breast Imaging, Toronto, ON (Canada); McCready, David [Princess Margaret Hospital, Department of Surgical Oncology, Toronto, ON (Canada); O' Malley, Frances [Mount Sinai Hospital, Department of Pathology, Laboratory Medicine, Toronto, ON (Canada)

2011-03-15

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision. (orig.)

Breast dynamic contrast enhanced MRI: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy