Contrast‐enhanced MRI of ductal carcinoma in situ: Characteristics of a new intensity‐modulated parametric mapping technique correlated with histopathologic findings

Mariano, Melissa; Bosch, Maurice A.A.J. van den; Daniel, Bruce L.; Nowels, Kent W.; Birdwell, Robyn L.; Fong, Kathy J.; Desmond, Pam S; Plevritis, Sylvia K.; Stables, Lara; Zakhour, Marowan; Herfkens, Robert J.; Ikeda, Debra M.

doi:10.1002/jmri.20405

Cited by 21 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, a late subtraction series should be routinely evaluated in the normal clinical setting as there are a few invasive lobular carcinomas that enhance slowly, additionally to premalignant or benign lesions, that could be of clinical relevance. Mariano et al showed that only 50% of the DCIS lesions enhance with type 2 or type 3 curves in the time signal intensity curve [32]. The late subtraction series may also be helpful to estimate the size of a malignant lesion as an eventually surrounding DCIS may be better identified in the late phase of the dynamic scan.…”

Section: Discussionmentioning

confidence: 98%

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

et al. 2007

View full text Add to dashboard Cite

We compared the detection of malignant lesions in two different methods of parametric-guided analysis to the widely used early subtraction images. The parametric colour-coded overlays were defined by the increase of signal intensity after contrast injection and the course of the time signal intensity curve. Exams of 30 patients with histopathological evidence of 32 invasive breast carcinomas were evaluated. Five hundred five areas of additional enhancing tissue were found in the early subtraction images. The sensitivity was 100 in the subtraction images and 100 and 93.8 in the parametric images, respectively, the specificity 67.5, 84.2 and 88.7, respectively. On average 4.4 ROI-measurements were needed to find the highest increase of signal intensity in the subtraction series compared to 1.9 in the parametric images. Properly selected thresholds in parametric imaging may be helpful in the differentiation of enhancing tissue. Furthermore the parametric image-guided ROI selection significantly speeds up the analysis and makes it safer as a lower rate of ROI-measurements is needed to find the strongest enhancement.

show abstract

Section: Discussionmentioning

confidence: 98%

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

et al. 2007

View full text Add to dashboard Cite

show abstract

“…They recommend either direct MR-guided vaccum-assisted biopsy or short-term follow-up breast MRI within 3 months 15 . Libermann et al found that the PPV of biopsy for lesions identifi ed in breast MRI signifi cantly increased with increasing size of the lesion and biopsy is rarely necessary for lesions smaller than 5 mm because of their low likelihood of cancer 19 . If the diagnostic centre for breast is interested in MRI examination seriously, it should be well equipped for doing biopsy and localization under MRI control.…”

Section: Discussionmentioning

confidence: 99%

The Value of Dynamic Contrast Enhanced Breast Mri in Mammographically Detected Bi-Rads 5 Microcalcifications

Houserková¹,

Prasad²,

Svach³

et al. 2008

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Aims:To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the diagnosis of BI-RADS-5 type of microcalcifi cations of the breast, to compare the size of the microcalcifi cation lesions using mammography (MG) and MRI, and to determine the value of MRI in surgery for microcalcifi cations. The study also determines the morphology of microcalcifi cation lesions, assesses kinetic curves and compare MRI features of ductal carcinoma in situ (DCIS) for diff erent histopathological grades.Methods: Our group consisted of 32 patients with mammographically detected BI-RADS 5 microcalcifi cations. The MRI was done in this group of women which was later followed by stereotactic vaccum-assisted biopsy (SVAB). Surgery was performed on all patients with a biopsy that resulted in a diagnosis of breast cancer or atypical ductal hyperplasia (ADH).Results: Of our group of 32 patients, there were 35 mammograhically detected microcalcifi cation lesions, 32 DCIS, one ADH and two benign fi ndings according to the fi nal histology.The microcalcifi cation lesions were larger using MRI than in MG in 10 women. We diagnosed DCIS multifocality in 6 women and bilateral carcinoma in one woman. As with kinetic curve assessment, we found in 67 % of DCIS a rapid rise, 27 % a moderate and in 6 % a slow initial rise. With the pattern of enhancement in the delayed phase, we found in 30 % of DCIS a washout pattern, 67 % a plateau and in 3 % a persistent pattern. Noted diff erence between high and low grade DCIS was confi rmed.Conclusions: MRI sensitivity in the detection of DCIS was 94 % in our group of patients and was the sole evidence for detection of multifocality and bilateral incidence of carcinoma. In 26 % of women the outcome of MRI was the most important for converting breast conserving surgery to mastectomy.

show abstract

“…Each high-resolution 3DSSMT pixel hue was modulated as a function of the corresponding k21 at the same location according to a color scheme ranging from blue (k21 = 0.00/sec-ond) to blue-green (k21 = 0.005/second), green (k21 = 0.01/second), green-yellow (k21 = 0.015/sec-ond), and yellow (k21> 0.02/second) (19). Using the parametric mapping technique, lesions were classified as suspicious if parametric maps revealed a green-yellow or yellow color, or if the k21 value was ≥ 0.015/second (6,7). A score for the overall likelihood of cancer was assessed for each lesion based on the combined lesion morphology, contrast dynamics, and k21 parametric mapping on MRI and rated using the ACR Breast Imaging and Reporting Data System (BIRADS) final assessments of 1–5, with 5 representing the highest suspicion of malignancy (18).…”

Section: Methodsmentioning

confidence: 99%

“…(14,15). However, results of previous studies also demonstrated that the choline levels may not be as greatly elevated in some breast cancers as they are in others, and sometimes are not detected at all, resulting in false-negative diagnoses (7,13,15). …”

mentioning

confidence: 94%

“…To optimize specificity in breast MRI combined high spatial-resolution imaging and rapid dynamic imaging for concurrent evaluation of detailed lesion morphology characteristics and contrast-enhancement dynamics is used, and can be combined for calculation of pharmacokinetic parameters and color parametric mapping of contrast dynamics (6,7). Calculation of the pharmacokinetic parameter k21, a redistribution rate constant that quantifies the exchange rate of the used contrast agent between the intra- and extravascular spaces, has a great overall ability to discriminate between benign and malignant breast disease on MRI, with higher k21 values in malignant lesions than in benign lesions (6).…”

mentioning

confidence: 99%

See 1 more Smart Citation

MRI and¹H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma

et al. 2008

Self Cite

View full text Add to dashboard Cite

To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton MR Spectroscopy ( 1 H MRS) exam in patients with invasive breast cancer. Sixteen patients with invasive ductal carcinoma of the breast were prospec-tively included and underwent both, contrast-enhanced breast MRI and 1 H MRS examination of the breast. The MR images were reviewed and the lesions morphologic features, enhancement patterns and pharmacokinetic parameters (k21-value) were scored according to the ACR BI-RADS-MRI lexicon criteria. For the in vivo MRS studies, each spectrum was evaluated for the presence of choline based on consensus reading. Breast MRI and 1 H MRS data were compared to histopathologic findings. In vivo 1 H MRS detected a choline peak in 14/16 (88%) cancers. A false-negative 1 H MRS study occurred in 2/16 (14%) cancer patients. K21 values differed between both groups: the 14 choline positive cancers had k21 values ranging from 0.01 to 0.20/second (mean 0.083/second), whereas the two choline-negative cancers showed k21 values of 0.03 and 0.05/second, respectively (mean 0.040/second). Also enhancement kinetics did differ between both groups; typically both cancers that were choline-negative showed a late phase plateau (100%), whereas this was only shown in 51/4 (36%) of the choline positive cases. There was no difference between both groups with regard to morphologic features on MRI. This study showed that false-negative 1 H MRS examinations do occur in breast cancer patients, and that the presence of a choline peak on 1 H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged.Keywords breast cancer; k21-value; magnetic resonance imaging; proton MR spectroscopy Contrast-enhanced breast magnetic resonance imaging (MRI) detects breast cancer with almost 100% sensitivity, and plays an increasingly important role in breast cancer detection and staging (1). However, the specificity of breast MRI is rather variable, ranging from 37% to 97%, resulting in moderate false-positive rates and unnecessary biopsies (2-5).To optimize specificity in breast MRI combined high spatial-resolution imaging and rapid dynamic imaging for concurrent evaluation of detailed lesion morphology characteristics and

show abstract

Contrast‐enhanced MRI of ductal carcinoma in situ: Characteristics of a new intensity‐modulated parametric mapping technique correlated with histopathologic findings

Cited by 21 publications

References 34 publications

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

The Value of Dynamic Contrast Enhanced Breast Mri in Mammographically Detected Bi-Rads 5 Microcalcifications

MRI and¹H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma

Contact Info

Product

Resources

About

Contrast‐enhanced MRI of ductal carcinoma in situ: Characteristics of a new intensity‐modulated parametric mapping technique correlated with histopathologic findings

Cited by 21 publications

References 34 publications

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

Dynamic breast MR imaging: is parametric mapping superior to image subtraction in lesion detection?

The Value of Dynamic Contrast Enhanced Breast Mri in Mammographically Detected Bi-Rads 5 Microcalcifications

MRI and1H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma

Contact Info

Product

Resources

About

MRI and¹H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma