Diagnostic performance characteristics of architectural features revealed by high spatial-resolution MR imaging of the breast.

Nunes, Linda White; Schnall, Mitchell D.; Siegelman, Evan S.; Langlotz, Curtis P.; Orel, Susan G.; Sullivan, Daniel C.; Muenz, L A; Reynolds, Carol; Torosian, Michael H.

doi:10.2214/ajr.169.2.9242744

Cited by 146 publications

(93 citation statements)

References 11 publications

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“…However, both high spatial resolution architectural imaging data and high temporal resolution contrast kinetic data could ideally be obtained in a single MR examination, and perhaps used in combination for greater diagnostic accuracy. Some investigators (21) have been evaluating single pulse sequences to try to allow this occurrence, but their spatial resolution does not yet equal that of studies designed to maximize spatial resolution (2)(3)(4)22,23). Although pulse sequences have been reported that can obtain both high spatial and high temporal resolution concurrently, their efficacy has not yet been clinically tested (24).…”

Section: Discussionmentioning

confidence: 99%

“…Reported specificities have been generally lower and highly variable, ranging from 37%-97% (1)(2)(3)(4)(5)(6). Many techniques are being investigated for their potential to improve the specificity of MR imaging of breast abnormalities, including architectural feature analysis (3), T1-weighted, timecourse of contrast enhancement evaluation (6,7), T2*-weighted first pass perfusion imaging (8), and MR spectroscopy (9).…”

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confidence: 99%

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Optimal post‐contrast timing of breast MR image acquisition for architectural feature analysis

Nunes

Englander

Charafeddine

et al. 2002

Magnetic Resonance Imaging

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Purpose: To define a post-contrast imaging time span during which diagnostic accuracy of breast magnetic resonance (MR) architectural feature analysis is maintained. Materials and Methods:Seventy-five patients with mammographically-visible or palpable findings underwent MR examination. Three sequential post-contrast, fat-saturated, three-dimensional gradient-echo imaging runs were acquired spanning 0 -90, 90 -180, and 180 -270 seconds after contrast injection. Five readers independently predicted the malignant potential of the MR abnormalities.Results: Receiver-operator characteristics (ROC) curves were our primary measure of diagnostic accuracy. The accuracy of four readers was unchanged over the three postcontrast runs. One reader was slightly more accurate using the second and third runs than using the first. Conclusion:For most readers, a single post-contrast run performed at any point during the first four minutes and 30 seconds following injection should yield an equivalent diagnostic accuracy. If any time period is less optimal, it is that of our first run, performed between 0 -90 seconds after contrast injection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Optimal post‐contrast timing of breast MR image acquisition for architectural feature analysis

Nunes

Englander

Charafeddine

et al. 2002

Magnetic Resonance Imaging

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“…Our indications are classical according to the published referential and cases may be divided between the following groups: staging before treatment planning, screening of high-risk females, evaluation of response to neoadjuvant chemotherapy, patients with breast augmentation or reconstruction, occult primary breast cancer, breast cancer recurrence and characterisation of equivocal findings [8]. Our MRI (1.5 T unit) protocol may be defined as follows: bilateral morphological study using bilateral unenhanced high-spatial resolution T 2 weighted fast spin-echo sequence without fat saturation in the axial plane; bilateral three-dimensional gradientecho T 1 weighted dynamic sequences in the axial plane; with or without fat saturation according to the radiologist; thickness between 2 and 3 mm according to the breast size; spatial in-plane resolution #1 mm 2 ; temporal resolution 60 s. We use intravenous injection of gadolinium chelates at the standard dose of 0.1 mmol kg 21 with an injection rate of 2 ml s 21 followed by saline flushing using an automatic injector. For dynamic studies performed both with and without fat saturation, image post-processing includes temporal subtraction; morphological in addition to dynamic analyses with representative curves are performed on native images in incidences of patient motion.…”

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confidence: 99%

Pearls and pitfalls in breast MRI

Millet¹,

Pagès²,

Hoa³

et al. 2012

BJR

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ABSTRACT. At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.

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“…As a result, the absorption of vascular contrast agents in malignant breast tissue is often different to that in benign and normal tissues. Today, contrast-enhanced MRI (CE-MRI), which uses a gadolinium chelate as a vascular contrast agent, is the standard for vascular imaging of breast cancers [2][3][4][5][6][7]. Breast lesion characterisation with CE-MRI relies on a combination of the analysis of the morphological features of the lesion and the vascular enhancement kinetics.…”

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confidence: 99%

Dual-energy contrast-enhanced digital breast tomosynthesis – a feasibility study

Carton

Gavenonis²,

Currivan³

et al. 2010

BJR

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ABSTRACT. Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel modality for imaging breast lesion morphology and vascularity. The purpose of this study is to assess the feasibility of dual-energy subtraction as a technique for CE-DBT (a temporal subtraction CE-DBT technique has been described previously). As CE-DBT evolves, exploration of alternative image acquisition techniques will contribute to its optimisation. Evaluation of dual-energy CE-DBT was conducted with Institutional Review Board (IRB) approval from our institution and in compliance with federal Health Insurance Portability and Accountability Act (HIPAA) guidelines. A 55-year old patient with a known malignancy in the right breast underwent imaging with MRI and CE-DBT. CE-DBT was performed in the medial lateral oblique view with a DBT system, which was modified under IRB approval to allow high-energy image acquisition with a 0.25 mm Cu filter. Image acquisition occurred via both temporal and dual-energy subtraction CE-DBT. Between the pre-and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1.0 ml kg -1 ) was administered, followed by a 60 ml saline flush. The contrast agent and saline were administrated manually at a rate of ,2 ml s -1 . Images were reconstructed using filtered-back projection and transmitted to a clinical PACS workstation. Dual-energy CE-DBT was shown to be clinically feasible. In our index case, the dual-energy technique was able to provide morphology and kinetic information about the known malignancy. This information was qualitatively concordant with that of CE-MRI. Compared with the temporal subtraction CE-DBT technique, dual-energy CE-DBT appears less susceptible to motion artefacts. Breast tumour growth and metastasis are accompanied by the development of new blood vessels that have an abnormally increased permeability [1]. As a result, the absorption of vascular contrast agents in malignant breast tissue is often different to that in benign and normal tissues. Today, contrast-enhanced MRI (CE-MRI), which uses a gadolinium chelate as a vascular contrast agent, is the standard for vascular imaging of breast cancers [2][3][4][5][6][7]. Breast lesion characterisation with CE-MRI relies on a combination of the analysis of the morphological features of the lesion and the vascular enhancement kinetics.Preliminary studies have demonstrated that contrastenhanced digital breast tomosynthesis (CE-DBT) using an iodinated vascular contrast agent has the potential to demonstrate morphology and vascular enhancement information concordant with that of CE-MRI [8]. As the clinical uses of CE-MRI continue to expand, investigation into a potential alternative such as CE-DBT (which is projected to be less costly and more widely available than MRI) may also increase in importance.Two CE X-ray imaging techniques have been proposed: temporal and dual-energy subtraction. In temporal subtraction breast X-ray imaging, one pre-contrast and one (or more) post-contrast time-points are acquired using a spectrum pred...

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Diagnostic performance characteristics of architectural features revealed by high spatial-resolution MR imaging of the breast.

Cited by 146 publications

References 11 publications

Optimal post‐contrast timing of breast MR image acquisition for architectural feature analysis

Optimal post‐contrast timing of breast MR image acquisition for architectural feature analysis

Pearls and pitfalls in breast MRI

Dual-energy contrast-enhanced digital breast tomosynthesis – a feasibility study

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