The purpose of this exploratory study was to correlate kinetic and morphologic MR features with histologic prognostic factors in invasive breast cancer. Sixty-one women with invasive breast cancer underwent dynamic contrast-enhanced MR imaging at 1.5 T, using T1-weighted 3D fast low-angle shot technique. The MR characteristics were correlated with classical pathologic prognostic factors (tumor size, histologic type, grade and lymph node status) and immunohistochemically detected biomarkers [c-erbB-2, p53, Ki-67, and estrogen receptor (ER)]. Univariate and multivariate statistical analyses were performed. Presence of rim enhancement pattern, early maximal enhancement and washout phenomenon were independently associated with established predictors of poor prognosis (higher histologic grade, positive Ki-67, and negative ER status). Our results suggest that these MR signs are not only important in differentiating benign from malignant lesions, but may also be useful to noninvasively identify highly aggressive breast carcinomas.

A multicentre study was undertaken to provide fundamentals for improved standardization and optimized interpretation guidelines of dynamic contrast-enhanced MRI. Only patients scheduled for biopsy of a clinical or imaging abnormality were included. They underwent standardized dynamic MRI on Siemens 1.0 (163 valid lesions > or = 5 mm) or 1.5 T (395 valid lesions > or = 5 mm) using 3D fast low-angle shot (FLASH; 87 s) before and five times after standardized bolus of 0.2 mmol Gd-DTPA/kg. One-Tesla and 1.5 T data were analysed separately using a discriminant analysis. Only histologically correlated lesions entered the statistical evaluation. Histopathology and imaging were correlated in retrospect and in open. The best results were achieved by combining up to five wash-in or wash-out parameters. Different weighting of false-negative vs false-positive calls allowed formulation of a statistically based interpretation scheme yielding optimized rules for the highest possible sensitivity (specificity 30%), for moderate (50%) or high (64-71%) specificity. The sensitivities obtained at the above specificity levels were better at 1.0 T (98, 97, or 96%) than at 1.5 T (96, 93, 86%). Using a widely available standardized MR technique definition of statistically founded interpretation rules is possible. Choice of an optimum interpretation rule may vary with the clinical question. Prospective testing remains necessary. Differences of 1.0 and 1.5 T are not statistically significant but may be due to pulse sequences.

Time-to-peak enhancement and the descriptor of margins appear to be the most important diagnostic criteria for mass lesions in dynamic breast MR imaging.

Time-to-peak enhancement and the descriptor of margins appear to be the most important diagnostic criteria for mass lesions in dynamic breast MR imaging.