Do T2‐weighted pulse sequences help with the differential diagnosis of enhancing lesions in dynamic breast MRI?

Abstract

In this study, our purpose was to determine whether T2-weighted images are a useful diagnostic adjunct for lesion characterization in dynamic breast MRI. On a 1.5-T system, 205 enhancing benign and malignant breast tumors were examined. The standardized protocol consisted of a T2-weighted turbo spin echo (TSE) pulse sequence with and without spectral fat suppression (SPIR), followed by a two-dimensional dynamic series with subtraction postprocessing. In 59 cases, T2*-weighted gradient-echo images also were obtained. Two independent radiologists visually rated the lesions (101 malignant, 104 benign) as having either a low or a high signal with respect to the adjacent glandular tissue. To assess age dependency of lesion enhancement velocities and T2-TSE signal intensities, we compared the results for patients at or below the age of 50 (group A), between 40 and 50 (group B), and beyond the age of 50 (group C). In T2-weighted TSE images, breast cancers were iso-or hypointense with respect to breast parenchyma in 87% of cases, whereas fibroadenomas were hyperintense in 71%. Visual assessment of lesion appearance in T2-weighted TSE images allowed to distinguish between fibroadenomas and breast cancers, with a respective sensitivity, specificity, positive predictive value, and negative predictive value of 72%, 75%, 46%, and 90% for young patients; 94%, 66%, 78%, and 89% for the patients between 40 and 50; and 89%, 62%, 85%, and 68% for the patients over 50 years of age. No significant difference was found for the distribution of signal intensities of lesions in T2*-weighted images or in fat-suppressed images. In a contrast-enhancing breast lesion, careful analysis of T2-weighted TSE images can improve differential diagnosis. The accuracy of this criterion varies with age. J. Magn.

Imaging of Breast Lesions Using Conventional Magnetic Resonance Imaging and Diffusion Weighted Imaging

“…Thus sensitivity of T2WI to detect malignant lesions was found to be 95%, specificity being 80.6%.This is in accordance with studies conducted by Kuhl et al, (1) in which majority (87%) malignant lesions were isointense or hypointense on T2WI. Malich et al, (2) concluded that most malignant lesions were hypointense on T2WI.…”

Pearls and pitfalls in breast MRI

“…This is classically considered to be a clear sign of fibroadenoma [25]; however, this finding has recently been questioned, with T 2 hypersignals described in several breast cancers including (predominantly) mucinous carcinomas, invasive ductal carcinomas, metaplastic carcinomas and intracystic papillary carcinomas [26,27]. In our experience ( Figure 5), as in the cases reported in these studies, the mass on T 2 weighted sequences generally does not have a homogeneous hyperintense sequence, whereas, in fibroadenomas, the hyperintense signal is homogeneous, except where there are thin septa [28].…”

Tissue microRNAs as Cancer Tissue Biomarkers

“…Despite positives in sensitivity, MRI lacks in specificity, making it difficult for clinicians to stage cancers. This difficulty adds unnecessary obstacles in the treatment process [4]. Other popular methods such as X-ray computed tomography (CT) have similar problems in staging due to low resolution, even with the use of contrast agents [5,6].…”