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Kim MK, Ko ES. Editorial for "Discriminative Factors of Malignancy of Ipsilateral Nonmass Enhancement in Women With Newly Diagnosed Breast Cancer on Initial Staging Breast MRI". J Magn Reson Imaging 2024; 59:1723-1724. [PMID: 37555691 DOI: 10.1002/jmri.28941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Ahmadinejad N, Azizinik F, Khosravi P, Torabi A, Mohajeri A, Arian A. Evaluation of Features in Probably Benign and Malignant Nonmass Enhancement in Breast MRI. Int J Breast Cancer 2024; 2024:6661849. [PMID: 38523651 PMCID: PMC10959584 DOI: 10.1155/2024/6661849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/08/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a highly sensitive breast imaging modality in detecting breast carcinoma. Nonmass enhancement (NME) is uniquely seen on MRI of the breast. The correlation between NME features and pathologic results has not been extensively explored. Our goal was to evaluate the characteristics of probably benign and suspicious NME lesions in MRI and determine which features are more associated with malignancy. We performed a retrospective research after approval by the hospital ethics committee on women who underwent breast MRI from March 2017 to March 2020 and identified 63 lesions of all 400 NME that were categorized as probably benign or suspicious according to the BI-RADS classification (version 2013). MRI features of NME findings including the location, size, distribution and enhancement pattern, kinetic curve, diffusion restriction, and also pathology result or 6-12-month follow-up MRI were evaluated and analyzed in each group (probably benign or suspicious NME). Vacuum-guided biopsies (VAB) were performed under mammographic or sonographic guidance and confirmed with MRI by visualization of the inserted clips. Segmental distribution and clustered ring internal enhancement were significantly associated with malignancy (p value<0.05), while linear distribution or homogeneous enhancement patterns were associated with benignity (p value <0.05). Additionally, the plateau and washout types in the dynamic curve were only seen in malignant lesions (p value <0.05). The presence of DWI restriction in NME lesions was also found to be a statistically important factor. Understanding the imaging findings of malignant NME is helpful to determine when biopsy is indicated. The correlation between NME features and pathologic results is critical in making appropriate management.
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Affiliation(s)
- Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Azizinik
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini and Yas Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pershang Khosravi
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ala Torabi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Liu Z, Yao B, Wen J, Wang M, Ren Y, Chen Y, Hu Z, Li Y, Liang D, Liu X, Zheng H, Luo D, Zhang N. Voxel-wise mapping of DCE-MRI time-intensity-curve profiles enables visualizing and quantifying hemodynamic heterogeneity in breast lesions. Eur Radiol 2024; 34:182-192. [PMID: 37566270 DOI: 10.1007/s00330-023-10102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES To propose a novel model-free data-driven approach based on the voxel-wise mapping of DCE-MRI time-intensity-curve (TIC) profiles for quantifying and visualizing hemodynamic heterogeneity and to validate its potential clinical applications. MATERIALS AND METHODS From December 2018 to July 2022, 259 patients with 325 pathologically confirmed breast lesions who underwent breast DCE-MRI were retrospectively enrolled. Based on the manually segmented breast lesions, the TIC of each voxel within the 3D whole lesion was classified into 19 subtypes based on wash-in rate (nonenhanced, slow, medium, and fast), wash-out enhancement (persistent, plateau, and decline), and wash-out stability (steady and unsteady), and the composition ratio of these 19 subtypes for each lesion was calculated as a new feature set (type-19). The three-type TIC classification, semiquantitative parameters, and type-19 features were used to build machine learning models for identifying lesion malignancy and classifying histologic grades, proliferation status, and molecular subtypes. RESULTS The type-19 feature-based model significantly outperformed models based on the three-type TIC method and semiquantitative parameters both in distinguishing lesion malignancy (respectively; AUC = 0.875 vs. 0.831, p = 0.01 and 0.875vs. 0.804, p = 0.03), predicting tumor proliferation status (AUC = 0.890 vs. 0.548, p = 0.006 and 0.890 vs. 0.596, p = 0.020), but not in predicting histologic grades (p = 0.820 and 0.970). CONCLUSION In addition to conventional methods, the proposed computational approach provides a novel, model-free, data-driven approach to quantify and visualize hemodynamic heterogeneity. CLINICAL RELEVANCE STATEMENT Voxel-wise intra-lesion mapping of TIC profiles allows for visualization of hemodynamic heterogeneity and its composition ratio for differentiation of malignant and benign breast lesions. KEY POINTS • Voxel-wise TIC profiles were mapped, and their composition ratio was compared between various breast lesions. • The model based on the composition ratio of voxel-wise TIC profiles significantly outperformed the three-type TIC classification model and the semiquantitative parameters model in lesion malignancy differentiation and tumor proliferation status prediction in breast lesions. • This novel, data-driven approach allows the intuitive visualization and quantification of the hemodynamic heterogeneity of breast lesions.
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Affiliation(s)
- Zhou Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 113 Baohe Avenue, 518116, Shenzhen, China
| | - Bingyu Yao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
- College of Computer and Information Engineering, Xiamen University of Technology, 600 Ligong Road, Xiamen, China
| | - Jie Wen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 113 Baohe Avenue, 518116, Shenzhen, China
| | - Meng Wang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 113 Baohe Avenue, 518116, Shenzhen, China
| | - Ya Ren
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 113 Baohe Avenue, 518116, Shenzhen, China
| | - Yuming Chen
- College of Computer and Information Engineering, Xiamen University of Technology, 600 Ligong Road, Xiamen, China
| | - Zhanli Hu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
| | - Ye Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 113 Baohe Avenue, 518116, Shenzhen, China.
| | - Na Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, China.
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Wu T, Alikhassi A, Curpen B. How Does Diagnostic Accuracy Evolve with Increased Breast MRI Experience? Tomography 2023; 9:2067-2078. [PMID: 37987348 PMCID: PMC10661242 DOI: 10.3390/tomography9060162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Introduction: Our institution is part of a provincial program providing annual breast MRI screenings to high-risk women. We assessed how MRI experience, background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) affect the biopsy-proven predictive value (PPV3) and accuracy for detecting suspicious MRI findings. Methods: From all high-risk screening breast MRIs conducted between 1 July 2011 and 30 June 2020, we reviewed all BI-RADS 4/5 observations with pathological tissue diagnoses. Overall and annual PPV3s were computed. Radiologists with fewer than ten observations were excluded from performance analyses. PPV3s were computed for each radiologist. We assessed how MRI experience, BPE, and FGT impacted diagnostic accuracy using logistic regression analyses, defining positive cases as malignancies alone (definition A) or malignant or high-risk lesions (definition B). Findings: There were 536 BI-RADS 4/5 observations with tissue diagnoses, including 77 malignant and 51 high-risk lesions. A total of 516 observations were included in the radiologist performance analyses. The average radiologist's PPV3 was 16 ± 6% (definition A) and 25 ± 8% (definition B). MRI experience in years correlated significantly with positive cases (definition B, OR = 1.05, p = 0.03), independent of BPE or FGT. Diagnostic accuracy improved exponentially with increased MRI experience (definition B, OR of 1.27 and 1.61 for 5 and 10 years, respectively, p = 0.03 for both). Lower levels of BPE significantly correlated with increased odds of findings being malignant, independent of FGT and MRI experience. Summary: More extensive MRI reading experience improves radiologists' diagnostic accuracy for high-risk or malignant lesions, even in MRI studies with increased BPE.
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Affiliation(s)
| | - Afsaneh Alikhassi
- Breast Imaging Division, Medical Imaging Department, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (T.W.); (B.C.)
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Li Y, Chen J, Yang Z, Fan C, Qin Y, Tang C, Yin T, Ai T, Xia L. Contrasts Between Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced MR in Diagnosing Malignancies of Breast Nonmass Enhancement Lesions Based on Morphologic Assessment. J Magn Reson Imaging 2023; 58:963-974. [PMID: 36738118 DOI: 10.1002/jmri.28600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nonmass enhancement (NME) breast lesions are considered to be the leading cause of unnecessary biopsies. Diffusion-weighted imaging (DWI) or dynamic contrast-enhanced (DCE) sequences are typically used to differentiate between benign and malignant NMEs. It is important to know which one is more effective and reliable. PURPOSE To compare the diagnostic performance of DCE curves and DWI in discriminating benign and malignant NME lesions on the basis of morphologic characteristics assessment on contrast-enhanced (CE)-MRI images. STUDY TYPE Retrospective. SUBJECTS A total of 180 patients with 184 lesions in the training cohort and 75 patients with 77 lesions in the validation cohort with pathological results. FIELD STRENGTH/SEQUENCE A 3.0 T/multi-b-value DWI (b values = 0, 50, 1000, and 2000 sec/mm2 ) and time-resolved angiography with stochastic trajectories and volume-interpolated breath-hold examination (TWIST-VIBE) sequence. ASSESSMENT In the training cohort, a diagnostic model for morphology based on the distribution and internal enhancement characteristics was first constructed. The apparent diffusion coefficient (ADC) model (ADC + morphology) and the time-intensity curves (TIC) model (TIC + morphology) were then established using binary logistic regression with pathological results as the reference standard. Both models were compared for sensitivity, specificity, and area under the curve (AUC) in the training and the validation cohort. STATISTICAL TESTS Receiver operating characteristic (ROC) curve analysis and two-sample t-tests/Mann-Whitney U-test/Chi-square test were performed. P < 0.05 was considered statistically significant. RESULTS For the TIC/ADC model in the training cohort, sensitivities were 0.924/0.814, specificities were 0.615/0.615, and AUCs were 0.811 (95%, 0.727, 0.894)/0.769 (95%, 0.681, 0.856). The AUC of the TIC-ADC combined model was significantly higher than ADC model alone, while comparable with the TIC model (P = 0.494). In the validation cohort, the AUCs of TIC/ADC model were 0.799/0.635. DATA CONCLUSION Based on the morphologic analyses, the performance of the TIC model was found to be superior than the ADC model for differentiating between benign and malignant NME lesions. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Yan Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Zhenlu Yang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Chanyuan Fan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjin Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caili Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yin
- MR Collaborations, Siemens Healthineers Ltd., Shanghai, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Meng L, Zhao X, Guo J, Lu L, Cheng M, Xing Q, Shang H, Wang K, Zhang B, Lei D, Zhang X. Evaluation of the differentiation of benign and malignant breast lesions using synthetic relaxometry and the Kaiser score. Front Oncol 2022; 12:964078. [PMID: 36303839 PMCID: PMC9595598 DOI: 10.3389/fonc.2022.964078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate whether there is added value of quantitative parameters from synthetic magnetic resonance imaging (SyMRI) as a complement to the Kaiser score (KS) to differentiate benign and malignant breast lesions. Materials and methods In this single-institution study, 122 patients who underwent breast MRI from March 2020 to May 2021 were retrospectively analyzed. SyMRI and dynamic contrast-enhanced MRI were performed using a 3.0-T system. Two experienced radiologists independently assigned the KS and measured the quantitative values of T1 relaxation time (T1), T2 relaxation time (T2), and proton density (PD) from SyMRI. Pathology was regarded as the gold standard. The diagnostic values were compared using the appropriate statistical tests. Results There were 122 lesions (86 malignant and 36 benign) in 122 women. The T1 value was identified as the only independent factor for the differentiation of malignant and benign lesions. The diagnostic accuracy of incorporating the T1 into the KS protocol (T1+KS) was 95.1% and 92.1% for all lesions (ALL) and The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions, respectively, which was significantly higher than that of either T1 (ALL: 82.8%, P = 0.0001; BI-RADS 4: 78.9%, P = 0.002) or KS (ALL: 90.2%, P = 0.031; BI-RADS 4: 84.2%, P = 0.031) alone. The sensitivity and specificity of T1+KS were also higher than those of the T1 or KS alone. The combined diagnosis could have avoided another 15.6% biopsies compared with using KS alone. Conclusions Incorporating T1 into the KS protocol improved both the sensitivity and specificity to differentiate benign and malignant breast lesions, thus avoiding unnecessary invasive procedures.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Guo
- General Electric (GE) Healthcare, MR Research China, Beijing, China
| | - Lin Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honglei Shang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- General Electric (GE) Healthcare, MR Research China, Beijing, China
| | - Bohao Zhang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongmei Lei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xiaoan Zhang,
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Jones MA, Islam W, Faiz R, Chen X, Zheng B. Applying artificial intelligence technology to assist with breast cancer diagnosis and prognosis prediction. Front Oncol 2022; 12:980793. [PMID: 36119479 PMCID: PMC9471147 DOI: 10.3389/fonc.2022.980793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/04/2022] [Indexed: 12/27/2022] Open
Abstract
Breast cancer remains the most diagnosed cancer in women. Advances in medical imaging modalities and technologies have greatly aided in the early detection of breast cancer and the decline of patient mortality rates. However, reading and interpreting breast images remains difficult due to the high heterogeneity of breast tumors and fibro-glandular tissue, which results in lower cancer detection sensitivity and specificity and large inter-reader variability. In order to help overcome these clinical challenges, researchers have made great efforts to develop computer-aided detection and/or diagnosis (CAD) schemes of breast images to provide radiologists with decision-making support tools. Recent rapid advances in high throughput data analysis methods and artificial intelligence (AI) technologies, particularly radiomics and deep learning techniques, have led to an exponential increase in the development of new AI-based models of breast images that cover a broad range of application topics. In this review paper, we focus on reviewing recent advances in better understanding the association between radiomics features and tumor microenvironment and the progress in developing new AI-based quantitative image feature analysis models in three realms of breast cancer: predicting breast cancer risk, the likelihood of tumor malignancy, and tumor response to treatment. The outlook and three major challenges of applying new AI-based models of breast images to clinical practice are also discussed. Through this review we conclude that although developing new AI-based models of breast images has achieved significant progress and promising results, several obstacles to applying these new AI-based models to clinical practice remain. Therefore, more research effort is needed in future studies.
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Affiliation(s)
- Meredith A. Jones
- School of Biomedical Engineering, University of Oklahoma, Norman, OK, United States
- *Correspondence: Meredith A. Jones,
| | - Warid Islam
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, United States
| | - Rozwat Faiz
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, United States
| | - Xuxin Chen
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, United States
| | - Bin Zheng
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, United States
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din NMU, Dar RA, Rasool M, Assad A. Breast cancer detection using deep learning: Datasets, methods, and challenges ahead. Comput Biol Med 2022; 149:106073. [DOI: 10.1016/j.compbiomed.2022.106073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/21/2022] [Accepted: 08/27/2022] [Indexed: 12/22/2022]
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Liu G, Li Y, Chen SL, Chen Q. Non-mass enhancement breast lesions: MRI findings and associations with malignancy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:357. [PMID: 35433999 PMCID: PMC9011203 DOI: 10.21037/atm-22-503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 12/02/2022]
Abstract
Background Magnetic resonance imaging (MRI) is a multi-sequence imaging technique. Although MRI is the most sensitive method for detecting breast cancer, it is limited in evaluating the malignant possibility of non-mass enhanced (NME) breast lesions. It is also rarely reported whether MRI can further indicate the invasion of the lesions. In this article, we explore the differentiation of MRI characteristics between benign and malignant NME lesions and determine which features are associated with invasion. Methods The MRI findings of 118 NME lesions were evaluated retrospectively to explore the characteristics of the benign and malignant NME lesions in different MRI sequences including dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI). The difference of MRI findings between benign and malignant NME lesions were determined by Pearson χ2 test or Fisher's exact test, and the diagnostic value of features for malignancy was evaluated by receiver operating characteristic (ROC) curve. Results This study included 118 NME lesions (62 benign and 56 malignant) in 118 patients. We found a segmental distribution, clustered-ring enhancement, wash-out dynamic curve, and lower apparent diffusion coefficient (ADC) value (P=0.01, <0.001, 0.02, 0.001) were associated with malignancy. Wash-out dynamic curves, diffusion restriction on DWI, lower ADC values were more advantageous in distinguishing invasive NME cancer from benign lesions than ductal carcinoma in situ (DCIS) (P<0.001, <0.001, 0.027). Further analysis showed that there were statistical differences between invasive carcinoma and carcinoma in situ in terms of wash-out dynamic curves, diffusion restriction on DWI and lower ADC values (P=0.001, 0.014, 0.024). Conclusions MRI is a valuable way to identify malignant NME lesions and could predict the invasion of the lesions. Compared with carcinoma in situ, some sequences have more advantages in distinguishing invasive carcinoma from benign lesions.
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Affiliation(s)
- Gang Liu
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Li
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Si-Lu Chen
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Radiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qiao Chen
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Assessment of Suspected Breast Lesions in Early-Stage Triple-Negative Breast Cancer during Follow-Up after Breast-Conserving Surgery Using Multiparametric MRI. Int J Breast Cancer 2022; 2022:4299920. [PMID: 35223102 PMCID: PMC8881159 DOI: 10.1155/2022/4299920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background The local recurrence rate of triple-negative breast cancer (TNBC) can be as high as 12%.The standard treatment for early-stage TNBC is breast-conserving surgery (BCS), followed by postoperative radiotherapy with or without chemotherapy. However, detection of the local recurrence of the disease after radiotherapy is a major issue. Objective The aim of this study was at investigating the role of dynamic and functional magnetic resonance imaging (MRI) during follow-up after BCS and radiotherapy with/without chemotherapy to differentiate between locoregional recurrence and postoperative fibrosis. Patients and Methods. This prospective study was conducted at the oncology, radiology, and pathology departments, Tanta University. It involved 50 patients with early-stage TNBC who were treated with BCS, followed by radiotherapy with/without chemotherapy. The suspected lesions were evaluated during the follow-up period by sonomammography. All patients were subjected to MRI, including conventional sequences, diffusion-weighted imaging (DWI), and dynamic postcontrast study. Results Ten cases were confirmed as recurrent malignant lesions. After contrast administration, they all exhibited irregular T1 hypodense lesions of variable morphology with diffusion restriction and positive enhancement. Eight cases displayed a type III curve, while two showed a type II curve. Histopathological assessment was consistent with the MRI findings in all eight cases. The combination of the data produced by DWI-MRI and dynamic contrast-enhanced (DCE) MRI resulted in 100%sensitivity, 92.5% specificity, 90.9% positive predictive value, 100% negative predictive value, and 98% accuracy. Conclusion Combination of DWI-MRI and DCE-MRI could have high diagnostic value for evaluating postoperative changes in patients with TNBC after BCS, followed by radiotherapy with/without chemotherapy. Trial Registrations. No trial to be registered.
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Li Y, Yang ZL, Lv WZ, Qin YJ, Tang CL, Yan X, Guo YH, Xia LM, Ai T. Non-Mass Enhancements on DCE-MRI: Development and Validation of a Radiomics-Based Signature for Breast Cancer Diagnoses. Front Oncol 2021; 11:738330. [PMID: 34631572 PMCID: PMC8493069 DOI: 10.3389/fonc.2021.738330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose We aimed to assess the additional value of a radiomics-based signature for distinguishing between benign and malignant non-mass enhancement lesions (NMEs) on dynamic contrast-enhanced breast magnetic resonance imaging (breast DCE-MRI). Methods In this retrospective study, 232 patients with 247 histopathologically confirmed NMEs (malignant: 191; benign: 56) were enrolled from December 2017 to October 2020 as a primary cohort to develop the discriminative models. Radiomic features were extracted from one post-contrast phase (around 90s after contrast injection) of breast DCE-MRI images. The least absolute shrinkage and selection operator (LASSO) regression model was adapted to select features and construct the radiomics-based signature. Based on clinical and routine MR features, radiomics features, and combined information, three discriminative models were built using multivariable logistic regression analyses. In addition, an independent cohort of 72 patients with 72 NMEs (malignant: 50; benign: 22) was collected from November 2020 to April 2021 for the validation of the three discriminative models. Finally, the combined model was assessed using nomogram and decision curve analyses. Results The routine MR model with two selected features of the time-intensity curve (TIC) type and MR-reported axillary lymph node (ALN) status showed a high sensitivity of 0.942 (95%CI, 0.906 - 0.974) and low specificity of 0.589 (95%CI, 0.464 - 0.714). The radiomics model with six selected features was significantly correlated with malignancy (P<0.001 for both primary and validation cohorts). Finally, the individual combined model, which contained factors including TIC types and radiomics signatures, showed good discrimination, with an acceptable sensitivity of 0.869 (95%CI, 0.816 to 0.916), improved specificity of 0.839 (95%CI, 0.750 to 0.929). The nomogram was applied to the validation cohort, reaching good discrimination, with a sensitivity of 0.820 (95%CI, 0.700 to 0.920), specificity of 0.864 (95%CI,0.682 to 1.000). The combined model was clinically helpful, as demonstrated by decision curve analysis. Conclusions Our study added radiomics signatures into a conventional clinical model and developed a radiomics nomogram including radiomics signatures and TIC types. This radiomics model could be used to differentiate benign from malignant NMEs in patients with suspicious lesions on breast MRI.
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Affiliation(s)
- Yan Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenlu L Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhi Z Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, China
| | - Yanjin J Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caili L Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Yan
- Scientific Marketing, Siemens Healthcare Ltd., Shanghai, China
| | - Yihao H Guo
- Magnetic Resonance (MR) Collaboration, Siemens Healthcare, Guangzhou, China
| | - Liming M Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Samreen N, Mercado C, Heacock L, Chacko C, Partridge SC, Chhor C. Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques. JOURNAL OF BREAST IMAGING 2021; 3:387-398. [PMID: 38424773 DOI: 10.1093/jbi/wbaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.
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Affiliation(s)
- Naziya Samreen
- New York University, Department of Radiology, Garden City, NY, USA
| | - Cecilia Mercado
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Laura Heacock
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Celin Chacko
- New York University, Department of Radiology, Garden City, NY, USA
| | | | - Chloe Chhor
- NYU School of Medicine, Department of Radiology, New York, NY, USA
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13
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Reply to "Differentiating Benign Lesions From Areas of Malignant Nonmass Enhancement With MRI". AJR Am J Roentgenol 2020; 216:W8. [PMID: 33347354 DOI: 10.2214/ajr.20.24674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Matsuda M, Tsuda T, Ebihara R, Toshimori W, Takeda S, Okada K, Nakasuka K, Shiraishi Y, Suekuni H, Kamei Y, Kurata M, Kitazawa R, Mochizuki T, Kido T. Enhanced Masses on Contrast-Enhanced Breast: Differentiation Using a Combination of Dynamic Contrast-Enhanced MRI and Quantitative Evaluation with Synthetic MRI. J Magn Reson Imaging 2020; 53:381-391. [PMID: 32914921 DOI: 10.1002/jmri.27362] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The addition of synthetic MRI might improve the diagnostic performance of dynamic contrast-enhanced MRI (DCE-MRI) in patients with breast cancer. PURPOSE To evaluate the diagnostic value of a combination of DCE-MRI and quantitative evaluation using synthetic MRI for differentiation between benign and malignant breast masses. STUDY TYPE Retrospective, observational. POPULATION In all, 121 patients with 131 breast masses who underwent DCE-MRI with additional synthetic MRI were enrolled. FIELD STRENGTH/SEQUENCE 3.0 Tesla, T1 -weighted DCE-MRI and synthetic MRI acquired by a multiple-dynamic, multiple-echo sequence. ASSESSMENT All lesions were differentiated as benign or malignant using the following three diagnostic methods: DCE-MRI type based on the Breast Imaging-Reporting and Data System; synthetic MRI type using quantitative evaluation values calculated by synthetic MRI; and a combination of the DCE-MRI + Synthetic MRI types. The diagnostic performance of the three methods were compared. STATISTICAL TESTS Univariate (Mann-Whitney U-test) and multivariate (binomial logistic regression) analyses were performed, followed by receiver-operating characteristic curve (AUC) analysis. RESULTS Univariate and multivariate analyses showed that the mean T1 relaxation time in a breast mass obtained by synthetic MRI prior to injection of contrast agent (pre-T1 ) was the only significant quantitative value acquired by synthetic MRI that could independently differentiate between malignant and benign breast masses. The AUC for all enrolled breast masses assessed by DCE-MRI + Synthetic MRI type (0.83) was significantly greater than that for the DCE-MRI type (0.70, P < 0.05) or synthetic MRI type (0.73, P < 0.05). The AUC for category 4 masses assessed by the DCE-MRI + Synthetic MRI type was significantly greater than that for those assessed by the DCE-MRI type (0.74 vs. 0.50, P < 0.05). DATA CONCLUSION A combination of synthetic MRI and DCE-MRI improves the accuracy of diagnosis of benign and malignant breast masses, especially category 4 masses. Level of Evidence 4 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:381-391.
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Affiliation(s)
- Megumi Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takaharu Tsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rui Ebihara
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Wataru Toshimori
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shiori Takeda
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kanako Okada
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kaori Nakasuka
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yasuhiro Shiraishi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hiroshi Suekuni
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Mie Kurata
- Department of Pathology, Ehime University Proteo-Science Center, Toon, Japan.,Department of Analytical Pathology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan.,Department of Radiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
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15
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Kishimoto AO, Kataoka M, Iima M, Honda M, Miyake KK, Ohashi A, Ota R, Kataoka T, Sakurai T, Toi M, Togashi K. Evaluation of Malignant Breast Lesions Using High-resolution Readout-segmented Diffusion-weighted Echo-planar Imaging: Comparison with Pathology. Magn Reson Med Sci 2020; 20:204-215. [PMID: 32611938 PMCID: PMC8203479 DOI: 10.2463/mrms.mp.2020-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We aimed to investigate the performance of high resolution-diffusion-weighted imaging (HR-DWI) using readout-segmented echo-planar imaging in visualizing malignant breast lesions and evaluating their extent, using pathology as a reference. METHODS This retrospective study included patients who underwent HR-DWI with surgically confirmed malignant breast lesions. Two radiologists blinded to the final diagnosis evaluated HR-DWI independently and identified the lesions, measuring their maximum diameters. Another radiologist confirmed if those lesions were identical to the pathology. The maximum diameters of the lesions between HR-DWI and pathology were compared, and their correlations were calculated using Spearman's correlation coefficient. Apparent diffusion coefficient (ADC) values of the lesions were measured. RESULTS Ninety-five mass/64 non-mass lesions were pathologically confirmed in 104 females. Both radiologists detected the same 93 mass lesions (97.9%). Spearman's correlation coefficient for mass lesions were 0.89 and 0.90 (P < 0.0001 and 0001) for the two radiologists, respectively. The size differences within 10 mm were 90.3% (84/93) and 94.6% (88/93) respectively. One radiologist detected 35 non-mass lesions (54.7%) and another radiologist detected 32 non-mass lesions (50.0%), of which 28 lesions were confirmed as identical. Spearman's correlation coefficient for non-mass lesions were 0.59 and 0.22 (P = 0.0002 and 0.22), respectively. The mean ADC value of mass lesions and non-mass lesions were 0.80 and 0.89 × 10-3 mm2/s, respectively. CONCLUSION Using HR-DWI, malignant mass lesions were depicted with excellent agreement with the pathological evaluation. Approximately half of the non-mass lesions could not be identified, suggesting a current limitation of HR-DWI.
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Affiliation(s)
- Ayami Ohno Kishimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University.,Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Rie Ota
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
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Nonmass Enhancement Breast Lesions: Diagnostic Performance of Kinetic Assessment on Ultrafast and Standard Dynamic Contrast-Enhanced MRI in Comparison With Morphologic Evaluation. AJR Am J Roentgenol 2020; 215:511-518. [PMID: 32452698 DOI: 10.2214/ajr.19.21920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE. The purpose of this article was to evaluate the diagnostic performance of the kinetic parameters of ultrafast and standard dynamic contrast-enhanced MRI (DCE-MRI) compared with morphologic evaluation in differentiating benign from malignant nonmass enhancement (NME) breast lesions. MATERIALS AND METHODS. A total of 77 consecutive patients with 77 NMEs (23 benign and 54 malignant) underwent 3-T MRI, including one unenhanced and eight contrast-enhanced ultrafast DCE-MRI scans (7-second scans) and standard DCE-MRI scans. The two readers evaluated the lesions' likelihood of malignancy on a continuous scale from 0 to 100% as the morphologic score using standard DCE-MRI. The kinetic curves of ultrafast DCE-MRI were fitted using an empirical mathematical model, ΔS(t) = A × (1 - e-αt), where A is the upper limit of signal intensity, e is the Euler number, and alpha (s-1) is the rate of signal increase. The initial slope of the kinetic curve (A × α) and the initial AUC (AUC30, which is the integration of the kinetic curve from 0 to 30 seconds) were calculated. From standard DCE-MRI, initial enhancement rate and signal enhancement ratio (SER) were calculated. These parameters were compared between benign and malignant NMEs. RESULTS. The morphologic score of malignant NME was statistically significantly higher than that of benign NME (p < 0.0001). The upper limit of signal intensity, rate of signal increase, initial slope of the kinetic curve, and AUC30 of ultrafast DCE-MRI, initial enhancement rate, SER of standard DCE-MRI of malignant NMEs were statistically significantly higher than those of benign NMEs (p = 0.0011, 0.0045, < 0.0001, < 0.0001, 0.0017, and < 0.0001, respectively). AUC ROC analysis found no statistically significant difference between morphologic score, AUC30 of ultrafast DCE-MRI, or SER of standard DCE-MRI. CONCLUSION. The kinetic parameters of ultrafast and standard DCE-MRI were as effective as morphologic evaluation for differentiation between benign and malignant NMEs.
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Gao P, Kong X, Song Y, Song Y, Fang Y, Ouyang H, Wang J. Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy. J Cancer 2020; 11:4671-4682. [PMID: 32626513 PMCID: PMC7330700 DOI: 10.7150/jca.46329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/09/2020] [Indexed: 01/20/2023] Open
Abstract
With a high sensitivity of breast lesions, MRI can detect suspicious lesions which are occult in traditional breast examination equipment. However, the lower and variable specificity of MRI makes the MRI-guided intervention, including biopsies and localizations, necessary before surgery, especially for patients who need the treatment of breast-conserving surgery (BCS). MRI techniques and patient preparation should be first carefully considered before the intervention to avoid lengthening the procedure time and compromising targeting accuracy. Doctors and radiologists need to reconfirm the target of the lesion and be very familiar with the process approach and equipment techniques involving the computer-aided diagnosis (CAD) tools and the biopsy system and follow a correct way. The basic steps of MRI-guided biopsy and localization are nearly the same regardless of the vendor or platform, and this article systematically introduces detailed methods and techniques of MRI-guided intervention. The two interventions both face different challenging situations during procedures with solutions given in the article. Post-operative statistics show that the complications of MRI-guided intervention are infrequent and mild, and MRI-guided biopsy provides the pathological information for the subsequent surgical decisions and MRI-guided localization fully prepared for follow-up surgical biopsy. New techniques for MRI-guided intervention are also elaborated in the article, which leads to future development. In a word, MRI-guided intervention is a safe, accurate, and effective technique with a low complication rate and successful MRI-guided intervention is truly teamwork with efforts from patients to surgeons, radiologists, MRI technologists, and nurses.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ying Song
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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18
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Kishimoto AO, Kataoka M, Iima M, Honda M, Miyake KK, Ohashi A, Ota R, Kataoka T, Sakurai T, Toi M, Togashi K. The comparison of high-resolution diffusion weighted imaging (DWI) with high-resolution contrast-enhanced MRI in the evaluation of breast cancers. Magn Reson Imaging 2020; 71:161-169. [PMID: 32320723 DOI: 10.1016/j.mri.2020.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE We sought to investigate the performance of high resolution (HR) diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging (rs-EPI), compared with high-resolution contrast-enhanced MRI (HR CE-MRI) in terms of morphological accuracy, on the basis of the Breast Imaging and Reporting and Data System (BI-RADS) MRI descriptors and lesion size. METHODS This retrospective study included the image data of 94 patients with surgically confirmed malignant breast lesions who had undergone high resolution diffusion-weighted imaging (HR-DWI) and HR CE-MRI. Two radiologists blinded to the final diagnosis independently identified the lesions on HR-DWI, described the morphology of the lesions according to BI-RADS descriptors, and measured lesion size. HR CE-MRI was subsequently evaluated using the same procedure. The inter-method agreement of the morphology was assessed using kappa statistics. Correlation on size was also assessed. RESULTS Reader A detected 79 mass lesions and 37 non-mass lesions on HR-DWI and HR CE-MRI. Reader B detected 81 mass lesions and 33 non-mass lesions on HR-DWI and HR CE-MRI. Very high agreement (kappa = 0.81-0.89, p < .05) was observed in the shape and margin assessment of mass lesions, where agreement on internal enhancement/signals was moderate to substantial (kappa = 0.43-0.61, p < .05). Disagreement was mostly seen in the evaluation of rim enhancement. High agreement was observed for non-mass lesion distribution (kappa = 0.76-0.84, p < .05), and agreement on internal enhancement/signals was moderate to fair (kappa = 0.34-0.49, p < .05). Agreement among heterogeneous, clumped, and clustered-ring patterns was variable. Size assessment showed very strong correlation both in mass (Spearman's rho = 0.90-0.96, p < .0001) and non-mass lesions (Spearman's rho = 0.86, p < .0001). CONCLUSIONS The findings in morphology and lesion extent showed high agreement between HR-DWI and HR CE-MRI for malignant breast lesions. These results imply the potential of applying HR-DWI for evaluation of malignant breast lesions using BI-RADS MRI.
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Affiliation(s)
- Ayami Ohno Kishimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan; Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Rie Ota
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
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19
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Chen S, Guan X, Shu Z, Li Y, Cao W, Dong F, Zhang M, Shao G, Shao F. A New Application of Multimodality Radiomics Improves Diagnostic Accuracy of Nonpalpable Breast Lesions in Patients with Microcalcifications-Only in Mammography. Med Sci Monit 2019; 25:9786-9793. [PMID: 31860635 PMCID: PMC6936317 DOI: 10.12659/msm.918721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to assess a radiomic scheme that combines image features from digital mammography and dynamic contrast-enhanced MRI to improve classification accuracy of nonpalpable breast lesion (NBL) with Breast Imaging-Reporting and Data System (BI-RADS) 3–5 microcalcifications-only in mammography. Material/Methods This retrospective study was approved by the Internal Research Review and Ethical Committee of our hospital. We included 81 patients who underwent a three-dimensional digital breast X-ray wire positioning for local resection between October 2012 and November 2016. All patients underwent breast MRI and mammography before the treatment, and all obtained pathological confirmation. According to the pathological results, 41 patients with benign lesions were assigned to the benign group and 40 patients with malignant lesions were assigned to the malignant group. We used the random forest algorithm to select significant features and to test the single and multimodal classifiers using the Leave-One-Out-Cross-Validation method. An area under the receiver operating characteristic curve was also used to evaluate its discriminating performance. Results The multimodal classifier achieved AUC of 0.903, with a sensitivity of 82.5% and a specificity of 80.48%, which was better than any single modality. Conclusions Multimodal radiomics classification shows promising power in discriminating malignant lesions from benign lesions in NBL patients with BI-RADS 3–5 microcalcifications-only in mammography.
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Affiliation(s)
- Shujun Chen
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xiaojun Guan
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
| | - Yongfeng Li
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Surgery, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Wenming Cao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Department of Breast Oncology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland)
| | - Fei Dong
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Minming Zhang
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Guoliang Shao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Feng Shao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Gynecological Oncology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
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20
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Dual-energy computed tomography for evaluation of breast cancer: value of virtual monoenergetic images reconstructed with a noise-reduced monoenergetic reconstruction algorithm. Jpn J Radiol 2019; 38:154-164. [PMID: 31686294 DOI: 10.1007/s11604-019-00897-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the image quality and lesion visibility of virtual monoenergetic images (VMIs) reconstructed using a new monoenergetic reconstruction algorithm (nMERA) for evaluation of breast cancer. MATERIALS AND METHODS Forty-two patients with 46 breast cancers who underwent 4-phasic breast contrast-enhanced computed tomography (CT) using dual-energy CT (DECT) were enrolled. We selected the peak enhancement phase of the lesion in each patient. The selected phase images were generated by 120-kVp-equivalent linear blended (M120) and monoenergetic reconstructions from 40 to 80 keV using the standard reconstruction algorithm (sMERA: 40, 50, 60, 70, 80) and nMERA (40 +, 50 +, 60 +, 70 +, 80 +). The contrast-to-noise ratio (CNR) was calculated and objectively analyzed. Two independent readers subjectively scored tumor visibility and image quality each on a 5-point scale. RESULTS The CNR at 40 + and tumor visibility scores at 40 + and 50 + were significantly higher than those on M120. The CNR at 50 + was not significantly different from that on M120. However, the overall image quality score at 40 + was significantly lower than that at 50 + and on M120 (40 + vs M120, P < 0.0001 and 40 + vs 50 +, P = 0.0001). CONCLUSIONS VMI reconstructed with nMERA at 50 keV is preferable for evaluation of patients with breast cancer.
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21
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Negrão EMS, Souza JA, Marques EF, Bitencourt AGV. Breast cancer phenotype influences MRI response evaluation after neoadjuvant chemotherapy. Eur J Radiol 2019; 120:108701. [PMID: 31610321 DOI: 10.1016/j.ejrad.2019.108701] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/04/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate which factors may influence magnetic resonance imaging (MRI) performance in the detection of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC). METHOD This retrospective study included 219 patients diagnosed with invasive breast carcinoma who underwent breast MRI before and after NAC. The MRI findings were compared to gold standard pathological examinations. Resolution of invasive breast disease was defined as pCR. RESULTS The mean age of our cohort was 48 years (range: 20-85). The molecular subtypes included: Luminal B/Her-2 negative (n = 89; 40%), triple-negative (n = 69; 32%), Luminal B/Her-2 positive (n = 43; 20%), and Her-2 overexpression (n = 18; 8%). MRI analysis after NAC showed complete response in 76 cases (35%), while pathological analysis of surgical specimens after NAC detected pCR in 85 cases (39%). The accuracy of MRI in diagnosing pCR was 80%, with 69% sensitivity, 87% specificity, and positive and negative predictive values of 78% and 82%, respectively. The only factor statistically associated with a higher discordance rate between MRI and pathologic response was the presence of non-mass enhancement at pre-treatment MRI (p = 0.003). CONCLUSIONS MRI demonstrated good accuracy in predicting pCR after NAC among the breast cancer patients examined. However, non-mass enhancement at pre-treatment MRI negatively affected the diagnostic performance of MRI in assessing treatment response after NAC.
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Affiliation(s)
- Erika M S Negrão
- Prevention Institute - Hospital de Câncer de Barretos, Campinas, SP, Brazil
| | - Juliana A Souza
- Imaging Department - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Elvira F Marques
- Imaging Department - A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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Radovic N, Ivanac G, Divjak E, Biondic I, Bulum A, Brkljacic B. Evaluation of Breast Cancer Morphology Using Diffusion-Weighted and Dynamic Contrast-Enhanced MRI: Intermethod and Interobserver Agreement. J Magn Reson Imaging 2018; 49:1381-1390. [PMID: 30325549 DOI: 10.1002/jmri.26332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The capability of diffusion-weighted imaging (DWI) for morphological analysis of breast lesions is underexplored. PURPOSE To evaluate the utility of DWI for assessment of morphological features of breast cancer by comparing DWI and dynamic contrast-enhanced (DCE) MRI findings to determine intermethod and interobserver agreement. STUDY TYPE Retrospective. POPULATION Seventy-eight women with pathohistologically proven breast cancer. FIELD STRENGTH/SEQUENCE 1.5T. DWI and DCE images. ASSESSMENT Diffusion-weighted and DCE images were placed in two separate case sets. Three radiologists, blinded to all other information, independently evaluated each case set on two separate occasions. Lesions were interpreted according to the fifth edition of the ACR BI-RADS lexicon. STATISTICAL ANALYSIS Kappa (κ) statistics were calculated in order to assess intermethod and interobserver agreement. RESULTS For values that attained statistical significance (P < 0.05), intermethod agreement ranged from fair (κ = 0.22) for nonmass internal patterns to significant (κ = 0.8) for lesion type. On DWI, interobserver agreement varied from fair (κ = 0.34) for mass shape to significant (κ = 0.75) for lesion type. On DCE MRI, interobserver agreement varied from fair (κ = 0.27) for irregular vs. spiculated mass margin to perfect (κ = 1) for circumscribed vs. noncircumscribed mass margin. DATA CONCLUSION On the whole, there was moderate intermethod agreement. The values of interobserver agreement were mostly similar between DWI and DCE MRI. This suggests that DWI is applicable for morphological assessment of breast cancer, notwithstanding substantially inferior spatial resolution compared to DCE MRI. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1381-1390.
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Affiliation(s)
- Niko Radovic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gordana Ivanac
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Eugen Divjak
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Iva Biondic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Antonio Bulum
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
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Thakran S, Gupta P, Kabra V, Saha I, Jain P, Gupta R, Singh A. Characterization of breast lesion using T1-perfusion magnetic resonance imaging: Qualitative vs. quantitative analysis. Diagn Interv Imaging 2018; 99:633-642. [DOI: 10.1016/j.diii.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022]
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Leithner D, Moy L, Morris EA, Marino MA, Helbich TH, Pinker K. Abbreviated MRI of the Breast: Does It Provide Value? J Magn Reson Imaging 2018; 49:e85-e100. [PMID: 30194749 PMCID: PMC6408315 DOI: 10.1002/jmri.26291] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
MRI of the breast is the most sensitive test for breast cancer detection and outperforms conventional imaging with mammography, digital breast tomosynthesis, or ultrasound. However, the long scan time and relatively high costs limit its widespread use. Hence, it is currently only routinely implemented in the screening of women at an increased risk of breast cancer. To overcome these limitations, abbreviated dynamic contrast‐enhanced (DCE)‐MRI protocols have been introduced that substantially shorten image acquisition and interpretation time while maintaining a high diagnostic accuracy. Efforts to develop abbreviated MRI protocols reflect the increasing scrutiny of the disproportionate contribution of radiology to the rising overall healthcare expenditures. Healthcare policy makers are now focusing on curbing the use of advanced imaging examinations such as MRI while continuing to promote the quality and appropriateness of imaging. An important cornerstone of value‐based healthcare defines value as the patient's outcome over costs. Therefore, the concept of a fast, abbreviated MRI exam is very appealing, given its high diagnostic accuracy coupled with the possibility of a marked reduction in the cost of an MRI examination. Given recent concerns about gadolinium‐based contrast agents, unenhanced MRI techniques such as diffusion‐weighted imaging (DWI) are also being investigated for breast cancer diagnosis. Although further larger prospective studies, standardized imaging protocol, and reproducibility studies are necessary, initial results with abbreviated MRI protocols suggest that it seems feasible to offer screening breast DCE‐MRI to a broader population. This article aims to give an overview of abbreviated and fast breast MRI protocols, their utility for breast cancer detection, and their emerging role in the new value‐based healthcare paradigm that has replaced the fee‐for‐service model. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:e85–e100.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria A Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
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Goto M, Sakai K, Yokota H, Kiba M, Yoshida M, Imai H, Weiland E, Yokota I, Yamada K. Diagnostic performance of initial enhancement analysis using ultra-fast dynamic contrast-enhanced MRI for breast lesions. Eur Radiol 2018; 29:1164-1174. [DOI: 10.1007/s00330-018-5643-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/14/2018] [Accepted: 06/29/2018] [Indexed: 12/29/2022]
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26
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Mohamed RE, Zytoon HA, Amin MA. Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kawai M, Kataoka M, Kanao S, Iima M, Onishi N, Ohashi A, Sakaguchi R, Toi M, Togashi K. The Value of Lesion Size as an Adjunct to the BI-RADS-MRI 2013 Descriptors in the Diagnosis of Solitary Breast Masses. Magn Reson Med Sci 2017; 17:203-210. [PMID: 29213007 PMCID: PMC6039786 DOI: 10.2463/mrms.mp.2017-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: This study aimed to evaluate the MRI findings of breast solitary masses in diagnostic procedures to decide the appropriate category based on American College of Radiology (ACR) BI-RADS-MRI 2013, with the focus on lesion size. Methods: A retrospective review of 2,603 consecutive breast MRI reports identified 250 pathologically-proven solitary breast masses. Dynamic-contrast enhanced images and diffusion-weighted images were performed on a 3.0/1.5 Tesla Scanner with a 16/4 channel dedicated breast coil. MRI findings were re-evaluated according to ACR BI-RADS-MRI 2013. BI-RADS-MRI descriptors, lesion size and minimum apparent diffusion coefficient (ADC) value were statistically analyzed using univariate/multivariate logistic regression analysis and receiver operator characteristic (ROC) analysis. Based on the results, a diagnostic decision tree was constructed. Results: Of the 250 lesions, 152 (61%) were malignant and 98 (39%) were benign. In univariate logistic regression analysis, most of the BI-RADS descriptors, lesion size, and ADC value were significant. Lesion size and ADC value were binarized with optimal cut-off values of 12 mm and 1.1 × 10−3 mm2/s, respectively. Multivariate logistic regression analysis showed that lesion size (≥12 mm or not), margin (circumscribed or not), kinetics (washout or not) and internal enhancement characteristics (IEC) (rim enhancement present or absent) significantly contributed to the diagnosis (P < 0.05). Using these four significant parameters, a decision tree was constructed to categorize lesions into detailed assessment categories/subcategories (Category 4A, 4B, 4C and 5). Conclusion: Lesion size is an independent contributor in diagnosing solitary breast masses. Adding the information of lesion size to BI-RADS-MRI 2013 descriptors will allow more detailed categorizations.
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Affiliation(s)
- Makiko Kawai
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Shotaro Kanao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Natsuko Onishi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Rena Sakaguchi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
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Leithner D, Wengert G, Helbich T, Morris E, Pinker K. MRI in the Assessment of BI-RADS® 4 lesions. Top Magn Reson Imaging 2017; 26:191-199. [PMID: 28961568 DOI: 10.1097/rmr.0000000000000138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) lexicon, which is used ubiquitously to standardize reporting of breast magnetic resonance imaging (MRI), provides 7 BI-RADS assessment categories to indicate the level of suspicion of malignancy and guide further management. A BI-RADS category 4 assessment is assigned when an imaging abnormality does not fulfill the typical criteria for malignancy, but is suspicious enough to warrant a recommendation for biopsy. The BI-RADS category 4 assessment covers a wide range of probability of malignancy, from >2 to <95%. MRI is an essential noninvasive technique in breast imaging and the role of MRI in the assessment of ACR BI-RADS 4 lesions is manifold. In lesions classified as suspicious on imaging with mammography, digital breast tomosynthesis, and sonography, MRI can aid in the noninvasive differentiation of benign and malignant lesions and obviate unnecessary breast biopsies. When the suspicion of cancer is confirmed with MRI, concurrent staging of disease for treatment planning can be accomplished. This article will provide a comprehensive overview of the role of breast MRI in the assessment of ACR BI-RADS 4 lesions. In addition, we will discuss strategies to decrease false positives and avoid false negative results when reporting MRI of the breast.
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Affiliation(s)
- Doris Leithner
- *Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany †Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria ‡Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Milosevic ZC, Nadrljanski MM, Milovanovic ZM, Gusic NZ, Vucicevic SS, Radulovic OS. Breast Dynamic Contrast Enhanced MRI: Fibrocystic Changes Presenting as a Non-mass Enhancement Mimicking Malignancy. Radiol Oncol 2017; 51:130-136. [PMID: 28740447 PMCID: PMC5514652 DOI: 10.1515/raon-2017-0016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/20/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Zorica C Milosevic
- Clinic for Radiation Oncology and Radiology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mirjan M Nadrljanski
- Clinic for Radiation Oncology and Radiology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorka M Milovanovic
- Department for Pathology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Nina Z Gusic
- Primary Health Center Zvezdara, Belgrade, Serbia
| | - Slavko S Vucicevic
- Clinic for Radiation Oncology and Radiology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Olga S Radulovic
- Institute for Biological Research 'Sinisa Stankovic', Belgrade, Serbia
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Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening. AJR Am J Roentgenol 2017; 208:284-289. [DOI: 10.2214/ajr.16.17205] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Descriptors of Malignant Non-mass Enhancement of Breast MRI: Their Correlation to the Presence of Invasion. Acad Radiol 2016; 23:687-95. [PMID: 26976623 DOI: 10.1016/j.acra.2016.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/14/2016] [Accepted: 01/30/2016] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to investigate the clinical significance of malignant non-mass enhancement (NME) descriptors in breast magnetic resonance images by assessing their correlation to the presence of invasion or lymph node metastasis. MATERIALS AND METHODS Three radiologists independently reviewed magnetic resonance images with malignant NMEs between January 2008 and December 2009. Distribution was assessed first, and then each of four internal enhancement patterns-clumped, clustered ring, branching, and hypointense area-was evaluated dichotomously (yes or no). Because clustered rings and hypointense areas were thought to be major structural elements of heterogeneous NMEs, they were also evaluated by integrating them into one collective descriptor we called the "heterogeneous structures." Chi-square test, Fisher exact test, or Student t test was used to analyze differences of variables by each reviewer. Positive predictive values (PPVs) of descriptors in predicting presence of invasion or lymph node metastasis were calculated. P < 0.05 was considered significant. RESULTS We included 131 malignant NMEs (76 in situ and 55 invasive) in 129 patients (two bilateral). All three observers' results showed clustered rings (PPVs 54.5%, 54.5%, 50.0%) (P = 0.0005, 0.038, 0.029) and hypointense areas (PPVs 63.6%, 61.5%, 73.9%) (P = 0.004, 0.024, 0.0006) to be significantly associated with invasion. When clustered rings and hypointense areas were integrated into heterogeneous structures, they were significantly associated with invasion (PPVs 54.3%, 53.3%, 51.8%) (P = 0.0003, 0.016, 0.003). CONCLUSIONS The NME descriptors clustered rings, hypoechoic areas, and heterogeneous structures, assessed collectively, were associated with invasive breast cancer.
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Shimauchi A, Ota H, Machida Y, Yoshida T, Satani N, Mori N, Takase K, Tozaki M. Morphology evaluation of nonmass enhancement on breast MRI: Effect of a three-step interpretation model for readers' performances and biopsy recommendations. Eur J Radiol 2016; 85:480-8. [PMID: 26781155 DOI: 10.1016/j.ejrad.2015.11.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/15/2015] [Accepted: 11/22/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate and compare the use of a newly introduced interpretation model for breast nonmass enhancement (NME, defined as an area of enhancement without a three-dimensional, space-occupying lesion) with the use of the standard interpretation method based on BI-RADS. MATERIALS AND METHODS Two expert and two less-experienced breast imaging radiologists performed reading sessions of 86 malignant and 64 benign NME lesions twice. First, radiologists characterized NME using BI-RADS descriptors and assessed the likelihood of malignancy and need for a biopsy. Second, the likelihood of malignancy and need for a biopsy were assessed with the use of the model, in which three-step characterization of morphological features were performed: (1) selection of distribution modifiers, (2) homogeneous vs. heterogeneous internal enhancement (IE) pattern, and (3) evaluation of presence of "clumped", "clustered ring enhancement (CRE)", and "branching" IE signs. Multireader-multicase receiver operating characteristic analysis was used to evaluate observers' performances. Univariate and multivariate logistic regression analyses were performed for morphology descriptors. RESULTS With use of the model, average Az of less-experienced radiologists (0.77-0.83; p=0.013) and average sensitivity of all radiologists (96.2-98.2%; p=0.007) improved significantly. NPV also improved but nonsignificantly (81.1-91.9%; p=0.055). Multivariate analyses of the second reading showed branching, clumped, and CRE signs to be significant predictors of malignancy in the results of 3, 2, and 2 readers, respectively. CONCLUSION The three-step interpretation model for NME has the potential to improve less-experienced radiologists' performances, making them comparable to expert breast imagers.
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Affiliation(s)
- Akiko Shimauchi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo, Aoba-ku, Sendai 980-8574, Japan.
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo, Aoba-ku, Sendai 980-8574, Japan
| | - Youichi Machida
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1, Kyobashi, Chuo-ku 104-0031, Tokyo, Japan
| | - Tamiko Yoshida
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1, Kyobashi, Chuo-ku 104-0031, Tokyo, Japan
| | - Nozomi Satani
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo, Aoba-ku, Sendai 980-8574, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo, Aoba-ku, Sendai 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo, Aoba-ku, Sendai 980-8574, Japan
| | - Mitsuhiro Tozaki
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1, Kyobashi, Chuo-ku 104-0031, Tokyo, Japan; Department of Radiology, Sagara Hospital Affiliated Breast Center, 3-28 Tenokuchi-cho, Kagoshima 892-0845, Japan
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Principles and methods for automatic and semi-automatic tissue segmentation in MRI data. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:95-110. [DOI: 10.1007/s10334-015-0520-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022]
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Wang J, Kato F, Oyama-Manabe N, Li R, Cui Y, Tha KK, Yamashita H, Kudo K, Shirato H. Identifying Triple-Negative Breast Cancer Using Background Parenchymal Enhancement Heterogeneity on Dynamic Contrast-Enhanced MRI: A Pilot Radiomics Study. PLoS One 2015; 10:e0143308. [PMID: 26600392 PMCID: PMC4658011 DOI: 10.1371/journal.pone.0143308] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine the added discriminative value of detailed quantitative characterization of background parenchymal enhancement in addition to the tumor itself on dynamic contrast-enhanced (DCE) MRI at 3.0 Tesla in identifying "triple-negative" breast cancers. MATERIALS AND METHODS In this Institutional Review Board-approved retrospective study, DCE-MRI of 84 women presenting 88 invasive carcinomas were evaluated by a radiologist and analyzed using quantitative computer-aided techniques. Each tumor and its surrounding parenchyma were segmented semi-automatically in 3-D. A total of 85 imaging features were extracted from the two regions, including morphologic, densitometric, and statistical texture measures of enhancement. A small subset of optimal features was selected using an efficient sequential forward floating search algorithm. To distinguish triple-negative cancers from other subtypes, we built predictive models based on support vector machines. Their classification performance was assessed with the area under receiver operating characteristic curve (AUC) using cross-validation. RESULTS Imaging features based on the tumor region achieved an AUC of 0.782 in differentiating triple-negative cancers from others, in line with the current state of the art. When background parenchymal enhancement features were included, the AUC increased significantly to 0.878 (p<0.01). Similar improvements were seen in nearly all subtype classification tasks undertaken. Notably, amongst the most discriminating features for predicting triple-negative cancers were textures of background parenchymal enhancement. CONCLUSIONS Considering the tumor as well as its surrounding parenchyma on DCE-MRI for radiomic image phenotyping provides useful information for identifying triple-negative breast cancers. Heterogeneity of background parenchymal enhancement, characterized by quantitative texture features on DCE-MRI, adds value to such differentiation models as they are strongly associated with the triple-negative subtype. Prospective validation studies are warranted to confirm these findings and determine potential implications.
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Affiliation(s)
- Jeff Wang
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, Hokkaido, 060–8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, United States of America
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Yi Cui
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Khin Khin Tha
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, Hokkaido, 060–8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Hokkaido University Hospital, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, Hokkaido, 060–8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Proton Beam Therapy Center, North 14 West 5 Kita-ku, Sapporo, Hokkaido, 060–8648, Japan
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Machida Y, Tozaki M, Shimauchi A, Yoshida T. Two Distinct Types of Linear Distribution in Nonmass Enhancement at Breast MR Imaging: Difference in Positive Predictive Value between Linear and Branching Patterns. Radiology 2015; 276:686-94. [DOI: 10.1148/radiol.2015141775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Integration of DCE-MRI and DW-MRI Quantitative Parameters for Breast Lesion Classification. BIOMED RESEARCH INTERNATIONAL 2015; 2015:237863. [PMID: 26339597 PMCID: PMC4538369 DOI: 10.1155/2015/237863] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the diagnostic value of an imaging protocol combining dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI) in patients with suspicious breast lesions. MATERIALS AND METHODS A total of 31 breast lesions (15 malignant and 16 benign proved by histological examination) in 26 female patients were included in this study. For both DCE-MRI and DW-MRI model free and model based parameters were computed pixel by pixel on manually segmented ROIs. Statistical procedures included conventional linear analysis and more advanced techniques for classification of lesions in benign and malignant. RESULTS Our findings indicated no strong correlation between DCE-MRI and DW-MRI parameters. Results of classification analysis show that combining of DCE parameters or DW-MRI parameter, in comparison of single feature, does not yield a dramatic improvement of sensitivity and specificity of the two techniques alone. The best performance was obtained considering a full combination of all features. Moreover, the classification results combining all features are dominated by DCE-MRI features alone. CONCLUSION The combination of DWI and DCE-MRI does not show a potential to dramatically increase the sensitivity and specificity of breast MRI. DCE-MRI alone gave the same performance as in combination with DW-MRI.
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Photoacoustic image patterns of breast carcinoma and comparisons with Magnetic Resonance Imaging and vascular stained histopathology. Sci Rep 2015; 5:11778. [PMID: 26159440 PMCID: PMC4498178 DOI: 10.1038/srep11778] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/26/2015] [Indexed: 12/19/2022] Open
Abstract
Photoacoustic (optoacoustic) imaging can visualize vasculature deep in tissue using the high contrast of hemoglobin to light, with the high-resolution possible with ultrasound detection. Since angiogenesis, one of the hallmarks of cancer, leads to increased vascularity, photoacoustics holds promise in imaging breast cancer as shown in proof-of-principle studies. Here for the first time, we investigate if there are specific photoacoustic appearances of breast malignancies which can be related to the tumor vascularity, using an upgraded research imaging system, the Twente Photoacoustic Mammoscope. In addition to comparisons with x-ray and ultrasound images, in subsets of cases the photoacoustic images were compared with MR images, and with vascular staining in histopathology. We were able to identify lesions in suspect breasts at the expected locations in 28 of 29 cases. We discovered generally three types of photoacoustic appearances reminiscent of contrast enhancement types reported in MR imaging of breast malignancies, and first insights were gained into the relationship with tumor vascularity.
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Combined reading of Contrast Enhanced and Diffusion Weighted Magnetic Resonance Imaging by using a simple sum score. Eur Radiol 2015; 26:884-91. [PMID: 26115653 DOI: 10.1007/s00330-015-3886-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/29/2015] [Accepted: 06/09/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To improve specificity of breast MRI by integrating Apparent Diffusion Coefficient (ADC) values with contrast enhanced MRI (CE-MRI) using a simple sum score. METHODS Retrospective analysis of a consecutive series of patients referred to breast MRI at 1.5 T for further workup of breast lesions. Reading results of CE-MRI were dichotomized into score 1 (suspicious) or 0 (benign). Lesion's ADC-values (in *10-3 mm2/s) were assigned two different scores: ADC2: likely malignant (score +1, ADC ≤ 1), indeterminate (score 0, ADC >1- ≤ 1.4) and likely benign (score -1, ADC > 1.4) and ADC1: indeterminate (score 0, ADC ≤ 1.4) and likely benign (score -1, ADC > 1.4). Final added CE-MRI and ADC scores >0 were considered suspicious. Reference standard was histology and imaging follow-up of >24 months. Diagnostic parameters were compared using McNemar tests. RESULTS A total of 150 lesions (73 malignant) were investigated. Reading of CE-MRI showed a sensitivity of 100 % (73/73) and a specificity of 81.8 % (63/77). Additional integration of ADC scores increased specificity (ADC2/ADC1, P = 0.008/0.001) without causing false negative results. CONCLUSION Using a simple sum score, ADC-values can be integrated with CE-MRI of the breast, improving specificity. The best approach is using one threshold to exclude cancer. KEY POINTS ADC is used to assign levels of suspicion to breast lesions. ADC values >1.4 *10 (-3) mm (2) /s are likely benign and effectively rule out malignancy. ADC values below ≤1*10 (-3) mm (2) /s) are likely malignant but may be false positive. CE-MRI (+1: suspicious, 0: benign) and ADC (0: indeterminate, -1: benign) scores are added. Sum scores >0 should be biopsied.
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van der Velden TA, Italiaander M, van der Kemp WJM, Raaijmakers AJE, Schmitz AMT, Luijten PR, Boer VO, Klomp DWJ. Radiofrequency configuration to facilitate bilateral breast (31) P MR spectroscopic imaging and high-resolution MRI at 7 Tesla. Magn Reson Med 2014; 74:1803-10. [PMID: 25521345 DOI: 10.1002/mrm.25573] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 11/10/2014] [Accepted: 11/14/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE High-resolution MRI combined with phospholipid detection may improve breast cancer grading. Currently, configurations are optimized for either high-resolution imaging or (31) P spectroscopy. To be able to perform both imaging as well as spectroscopy in a single session, we integrated a (1) H receiver array into a (1) H-(31) P transceiver at 7T. To ensure negligible signal loss due to coupling between elements, we investigated the use of a floating decoupling loop to enable bilateral MRI and (31) P MRS. METHODS Two quadrature double-tuned radiofrequency coils were designed for bilateral breast MR with active detuning at the (1) H frequency. The two coils were placed adjacent to each other and decoupled for both frequencies with a single resonant floating loop. Sensitivity of the bilateral configuration, facilitating space for a 26-element (1) H receive array, was compared with a transceiver configuration. RESULTS The floating loop was able to decouple the elements over 20 dB for both frequencies. Enlargement of the elements, to provide space for the receivers, and the addition of detuning electronics altered the (31) P sensitivity by 0.4 dB. CONCLUSION Dynamic contrast-enhanced scans of 0.7 mm isotropic, diffusion-weighted imaging, and (31) P MR spectroscopic imaging can be acquired at 7T in a single session as demonstrated in a patient with invasive ductal carcinoma.
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Affiliation(s)
- Tijl A van der Velden
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | | | - Wybe J M van der Kemp
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Alexander J E Raaijmakers
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - A M Th Schmitz
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Peter R Luijten
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Vincent O Boer
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Dennis W J Klomp
- University Medical Centre Utrecht, department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
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Pinker K, Helbich TH, Magometschnigg H, Fueger B, Baltzer P. [Molecular breast imaging. An update]. Radiologe 2014; 54:241-53. [PMID: 24557495 DOI: 10.1007/s00117-013-2580-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CLINICAL/METHODICAL ISSUE The aim of molecular imaging is to visualize and quantify biological, physiological and pathological processes at cellular and molecular levels. Molecular imaging using various techniques has recently become established in breast imaging. STANDARD RADIOLOGICAL METHODS Currently molecular imaging techniques comprise multiparametric magnetic resonance imaging (MRI) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), proton MR spectroscopy ((1)H-MRSI), nuclear imaging by breast-specific gamma imaging (BSGI), positron emission tomography (PET) and positron emission mammography (PEM) and combinations of techniques (e.g. PET-CT and multiparametric PET-MRI). METHODICAL INNOVATIONS Recently, novel techniques for molecular imaging of breast tumors, such as sodium imaging ((23)Na-MRI), phosphorus spectroscopy ((31)P-MRSI) and hyperpolarized MRI as well as specific radiotracers have been developed and are currently under investigation. PRACTICAL RECOMMENDATIONS It can be expected that molecular imaging of breast tumors will enable a simultaneous assessment of the multiple metabolic and molecular processes involved in cancer development and thus an improved detection, characterization, staging and monitoring of response to treatment will become possible.
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Affiliation(s)
- K Pinker
- Abteilung für Molekulare Bildgebung, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Lesion type and reader experience affect the diagnostic accuracy of breast MRI: a multiple reader ROC study. Eur J Radiol 2014; 84:86-91. [PMID: 25466772 DOI: 10.1016/j.ejrad.2014.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/13/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022]
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 reader experience (P=0.005) on diagnostic performance. CONCLUSIONS Non-mass lesion type and low reader experience negatively affect the diagnostic performance of breast MRI in a non-screening setting.
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Grøvik E, Bjørnerud A, Kurz KD, Kingsrød M, Sandhaug M, Storås TH, Gjesdal KI. Single bolus split dynamic MRI: Is the combination of high spatial and dual-echo high temporal resolution interleaved sequences useful in the differential diagnosis of breast masses? J Magn Reson Imaging 2014; 42:180-7. [DOI: 10.1002/jmri.24753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/27/2014] [Indexed: 01/18/2023] Open
Affiliation(s)
- Endre Grøvik
- Oslo University Hospital; Intervention Centre; Oslo Norway
- University of Oslo; Oslo Norway
| | - Atle Bjørnerud
- Oslo University Hospital; Intervention Centre; Oslo Norway
- University of Oslo; Oslo Norway
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Wang CH, Yin FF, Horton J, Chang Z. Review of treatment assessment using DCE-MRI in breast cancer radiation therapy. World J Methodol 2014; 4:46-58. [PMID: 25332905 PMCID: PMC4202481 DOI: 10.5662/wjm.v4.i2.46] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/31/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
As a noninvasive functional imaging technique, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is being used in oncology to measure properties of tumor microvascular structure and permeability. Studies have shown that parameters derived from certain pharmacokinetic models can be used as imaging biomarkers for tumor treatment response. The use of DCE-MRI for quantitative and objective assessment of radiation therapy has been explored in a variety of methods and tumor types. However, due to the complexity in imaging technology and divergent outcomes from different pharmacokinetic approaches, the method of using DCE-MRI in treatment assessment has yet to be standardized, especially for breast cancer. This article reviews the basic principles of breast DCE-MRI and recent studies using DCE-MRI in treatment assessment. Technical and clinical considerations are emphasized with specific attention to assessment of radiation treatment response.
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Ebrahimi M, Siegler P, Modhafar A, Holloway CMB, Plewes DB, Martel AL. Using surface markers for MRI guided breast conserving surgery: a feasibility survey. Phys Med Biol 2014; 59:1589-605. [PMID: 24614540 DOI: 10.1088/0031-9155/59/7/1589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient's position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient's arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient's arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient's arm is above the patient's head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm(3) in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM-displacements ranged from 0.9 to 9.3 mm and the Dice overlap score ranged from 20% to 80%. The registration procedure took less than 1 min to run on a standard PC. Alignment of pre-surgical supine MR images to the patient using surface markers on the breast for co-registration therefore appears to be feasible.
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Affiliation(s)
- Mehran Ebrahimi
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, ON, Canada, L1H 7K4
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Magometschnigg HF, Helbich T, Brader P, Abeyakoon O, Baltzer P, Füger B, Wengert G, Polanec S, Bickel H, Pinker K. Molecular imaging for the characterization of breast tumors. Expert Rev Anticancer Ther 2014; 14:711-22. [DOI: 10.1586/14737140.2014.885383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Saranathan M, Rettmann DW, Hargreaves BA, Lipson JA, Daniel BL. Variable spatiotemporal resolution three-dimensional Dixon sequence for rapid dynamic contrast-enhanced breast MRI. J Magn Reson Imaging 2013; 40:1392-9. [PMID: 24227703 DOI: 10.1002/jmri.24490] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/25/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate a new variable spatiotemporal resolution dynamic contrast-enhanced (DCE) MRI method termed DIfferential Subsampling with Cartesian Ordering (DISCO), for imaging of breast cancer. MATERIALS AND METHODS DISCO combines variable density, pseudorandom k-space segmentation and two-point Dixon fat-water separation for high spatiotemporal resolution breast DCE MRI. During the contrast wash-in phase, view sharing is used to achieve high temporal resolution. Forty patients referred for breast MRI were imaged, 26 using the proposed DISCO sequence and 14 using a conventional low-spatial-resolution dynamic sequence (VIBRANT-FLEX) on a 3 Tesla scanner. DISCO dynamic images from 14 patients were compared with VIBRANT-FLEX images from 14 other patients. The image quality assessed by radiologist image ranking in a blinded manner, and the temporal characteristics of the two sequences were compared. RESULTS A spatial resolution of 1.1 × 1.1 × 1.2 mm(3) (160 slices, 28 cm field of view) was achieved with axial bilateral coverage in 120 s. Dynamic images with ∼ 9 s effective temporal resolution were generated during the 2-min contrast wash-in phase. The image quality of DISCO dynamic images ranked significantly higher than low spatial resolution VIBRANT-FLEX images (19.5 versus 9.5, Mann-Whitney U-test P = 0.00914), with no significant differences in the maximum slope of aortic enhancement. CONCLUSION DISCO is a promising variable-spatiotemporal-resolution imaging sequence for capturing the dynamics of rapidly enhancing tumors as well as structural features postcontrast. A near 1-mm isotropic spatial resolution was achieved with postcontrast static phase images in 120 s and dynamic phase images acquired in 9 s per phase.
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Grøvik E, Bjørnerud A, Storås TH, Gjesdal KI. Split dynamic MRI: Single bolus high spatial-temporal resolution and multi contrast evaluation of breast lesions. J Magn Reson Imaging 2013; 39:673-82. [DOI: 10.1002/jmri.24206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 04/12/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Endre Grøvik
- Oslo University Hospital; The Intervention Centre; Oslo Norway
- University of Oslo; Oslo Norway
| | - Atle Bjørnerud
- Oslo University Hospital; The Intervention Centre; Oslo Norway
- University of Oslo; Oslo Norway
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Shao Z, Wang H, Li X, Liu P, Zhang S, Cao S. Morphological Distribution and Internal Enhancement Architecture of Contrast-Enhanced Magnetic Resonance Imaging in the Diagnosis of Non-Mass-Like Breast Lesions: A Meta-Analysis. Breast J 2013; 19:259-68. [DOI: 10.1111/tbj.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Zhenzhen Shao
- Department of Breast Imaging; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
| | - Haitao Wang
- Department of Interventional Therapy; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
| | - Xubin Li
- Department of Radiology; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
| | - Peifang Liu
- Department of Breast Imaging; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
| | - Shuping Zhang
- Department of Breast Imaging; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
| | - Shan Cao
- Department of Biotheraphy; Tianjin Medical University Cancer Institute and Hospital; Key Laboratory of Breast Cancer Prevention and Therapy; Tianjin Medical University; Ministry of Education; Key Laboratory of Cancer Prevention and Therapy; Tianjin; China
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van de Bank BL, Voogt IJ, Italiaander M, Stehouwer BL, Boer VO, Luijten PR, Klomp DWJ. Ultra high spatial and temporal resolution breast imaging at 7T. NMR IN BIOMEDICINE 2013; 26:367-75. [PMID: 23076877 DOI: 10.1002/nbm.2868] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 08/21/2012] [Accepted: 08/22/2012] [Indexed: 05/20/2023]
Abstract
There is a need to obtain higher specificity in the detection of breast lesions using MRI. To address this need, Dynamic Contrast-Enhanced (DCE) MRI has been combined with other structural and functional MRI techniques. Unfortunately, owing to time constraints structural images at ultra-high spatial resolution can generally not be obtained during contrast uptake, whereas the relatively low spatial resolution of functional imaging (e.g. diffusion and perfusion) limits the detection of small lesions. To be able to increase spatial as well as temporal resolution simultaneously, the sensitivity of MR detection needs to increase as well as the ability to effectively accelerate the acquisition. The required gain in signal-to-noise ratio (SNR) can be obtained at 7T, whereas acceleration can be obtained with high-density receiver coil arrays. In this case, morphological imaging can be merged with DCE-MRI, and other functional techniques can be obtained at higher spatial resolution, and with less distortion [e.g. Diffusion Weighted Imaging (DWI)]. To test the feasibility of this concept, we developed a unilateral breast coil for 7T. It comprises a volume optimized dual-channel transmit coil combined with a 30-channel receive array coil. The high density of small coil elements enabled efficient acceleration in any direction to acquire ultra high spatial resolution MRI of close to 0.6 mm isotropic detail within a temporal resolution of 69 s, high spatial resolution MRI of 1.5 mm isotropic within an ultra high temporal resolution of 6.7 s and low distortion DWI at 7T, all validated in phantoms, healthy volunteers and a patient with a lesion in the right breast classified as Breast Imaging Reporting and Data System (BI-RADS) IV.
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Affiliation(s)
- B L van de Bank
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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