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Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses in Breast DCE-MRI. J Digit Imaging 2018; 29:388-93. [PMID: 26691512 DOI: 10.1007/s10278-015-9856-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Our purpose in this study was to develop a computer-aided diagnosis (CAD) scheme for distinguishing between benign and malignant breast masses in dynamic contrast material-enhanced magnetic resonance imaging (DCE-MRI). Our database consisted 90 DCE-MRI examinations, each of which contained four sequential phase images; this database included 28 benign masses and 62 malignant masses. In our CAD scheme, we first determined 11 objective features of masses by taking into account the image features and the dynamic changes in signal intensity that experienced radiologists commonly use for describing masses in DCE-MRI. Quadratic discriminant analysis (QDA) was employed to distinguish between benign and malignant masses. As the input of the QDA, a combination of four objective features was determined among the 11 objective features according to a stepwise method. These objective features were as follows: (i) the change in signal intensity from 2 to 5 min; (ii) the change in signal intensity from 0 to 2 min; (iii) the irregularity of the shape; and (iv) the smoothness of the margin. Using this approach, the classification accuracy, sensitivity, and specificity were shown to be 85.6 % (77 of 90), 87.1 % (54 of 62), and 82.1 % (23 of 28), respectively. Furthermore, the positive and negative predictive values were 91.5 % (54 of 59) and 74.2 % (23 of 31), respectively. Our CAD scheme therefore exhibits high classification accuracy and is useful in the differential diagnosis of masses in DCE-MRI images.
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Galea N, Francone M, Fiorelli A, Noce V, Giannetta E, Chimenti C, Frustaci A, Catalano C, Carbone I. Early myocardial gadolinium enhancement in patients with myocarditis: Validation of "Lake Louise consensus" criteria using a single bolus of 0.1mmol/Kg of a high relaxivity gadolinium-based contrast agent. Eur J Radiol 2017; 95:89-95. [PMID: 28987703 DOI: 10.1016/j.ejrad.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/22/2017] [Accepted: 07/15/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Global early gadolinium enhancement (EGE) is an accepted cardiac magnetic resonance (CMR) criterion for diagnosis of myocarditis. However, recommended enhancement thresholds are based specifically on standard-relaxivity Gd-chelates. We evaluated the performance of a high relaxivity MR contrast agent for detection of myocardial hyperemia in patients referred for endomyocardial biopsy (EMB). METHODS We retrospectively enrolled 54 patients (mean age: 44.1 years [range=18-77years]; 72% men) with suspected myocarditis who underwent CMR and EMB within four weeks of clinical onset. CMR imaging protocol included T2-weighted short tau inversion-recovery sequence, EGE and late gadolinium enhanced (LGE) imaging. For EGE imaging, free-breathing ECG-gated turbo spin echo T1-weighted (TSE T1w) sequences were acquired before and within the first three minutes after gadobenate dimeglumine (0.1mmol/Kg) administration. The ratio (EGEr) between myocardial and musculoskeletal early enhancement was calculated. Myocardial edema, EGE and late gadolinium enhancement (LGE) were correlated with EMB results. Receiver operating characteristic (ROC) curve analysis of EGE values was applied on the overall population. RESULTS EMB revealed myocarditis in 34/54 patients. Sensitivity, specificity and accuracy values of 0.61, 0.85 and 0.70, respectively, were obtained for a standard EGE threshold (EGEr>4.0). ROC analysis revealed an area under the curve of 0.701 for EGEr (IC95%:0.556-0.846, p=0.014) and 0.706 for absolute enhancement (IC95%:0.563-0.849, p=0.012). Sensitivity, specificity and accuracy values were 0.67, 0.80 and 0.72, respectively, for myocardial edema and 0.76, 0.75 and 0.76, respectively, for LGE. CONCLUSIONS High relaxivity contrast agents provide comparable results to standard-relaxivity chelates for EGE assessment in diagnosing myocarditis.
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Affiliation(s)
- Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Andrea Fiorelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Vincenzo Noce
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy.
| | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy.
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
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Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis. Insights Imaging 2015; 7:99-110. [PMID: 26555392 PMCID: PMC4729715 DOI: 10.1007/s13244-015-0444-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 12/21/2022] Open
Abstract
Abstract Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.
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Fallenberg EM, Renz DM, Karle B, Schwenke C, Ingod-Heppner B, Reles A, Engelken FJ, Huppertz A, Hamm B, Taupitz M. Intraindividual, randomized comparison of the macrocyclic contrast agents gadobutrol and gadoterate meglumine in breast magnetic resonance imaging. Eur Radiol 2014; 25:837-49. [PMID: 25249313 DOI: 10.1007/s00330-014-3426-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/19/2014] [Accepted: 08/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare intraindividually two macrocyclic contrast agents - gadobutrol and gadoterate meglumine (Gd-DOTA) - for dynamic and quantitative assessment of relative enhancement (RE) in benign and malignant breast lesions. METHODS This was an ethically approved, prospective, single-centre, randomized, crossover study in 52 women with suspected breast lesions referred for magnetic resonance imaging (MRI). Each patient underwent one examination with gadobutrol and one with Gd-DOTA (0.1 mmol/kg BW) on a 1.5 T system 1 - 7 days apart. Dynamic, T1-weighted, 3D gradient echo sequences were acquired under identical conditions. Quantitative evaluation with at least three regions of interest (ROI) per lesion was performed. Primary endpoint was RE during the initial postcontrast phase after the first and second dynamic acquisition, and peak RE. All lesions were histologically proven; differences between the examinations were evaluated. RESULTS Forty-five patients with a total of 11 benign and 34 malignant lesions were assessed. Mean RE was significantly higher for gadobutrol than Gd-DOTA (p < 0.0001). Gadobutrol showed significantly less washout (64.4 %) than Gd-DOTA (75.4 %) in malignant lesions (p = 0.048) CONCLUSIONS: Gadobutrol has higher RE values compared with Gd-DOTA, whereas Gd-DOTA shows more marked washout in malignant lesions. This might improve the detection of breast lesions and influence the specificity of breast MRI-imaging.
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Affiliation(s)
- Eva M Fallenberg
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Comparison of Gadoteric Acid and Gadobutrol for Detection as Well as Morphologic and Dynamic Characterization of Lesions on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Invest Radiol 2014; 49:474-84. [DOI: 10.1097/rli.0000000000000039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khouri Chalouhi K, Papini GD, Bandirali M, Sconfienza LM, Di Leo G, Sardanelli F. Less is better? Intraindividual and interindividual comparison between 0.075 mmol/kg of gadobenate dimeglumine and 0.1 mmol/kg of gadoterate meglumine for cranial MRI. Eur J Radiol 2014; 83:1245-1249. [DOI: 10.1016/j.ejrad.2014.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/17/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
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Yang Q, Li L, Zhang J, Shao G, Zheng B. A computerized global MR image feature analysis scheme to assist diagnosis of breast cancer: a preliminary assessment. Eur J Radiol 2014; 83:1086-1091. [PMID: 24743001 DOI: 10.1016/j.ejrad.2014.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/02/2014] [Accepted: 03/10/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors. MATERIALS AND METHODS The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases. RESULTS In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898]. CONCLUSIONS We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer.
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Affiliation(s)
- Qian Yang
- College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Lihua Li
- College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China.
| | - Juan Zhang
- Zhejiang Cancer Hospital, Hangzhou, 310010, China
| | | | - Bin Zheng
- College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China; School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
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Morana G, Cugini C, Scatto G, Zanato R, Fusaro M, Dorigo A. Use of contrast agents in oncological imaging: magnetic resonance imaging. Cancer Imaging 2013; 13:350-9. [PMID: 24060901 PMCID: PMC3781607 DOI: 10.1102/1470-7330.2013.9018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Magnetic resonance plays a leading role in the management of oncology patients, providing superior contrast resolution and greater sensitivity compared with other techniques, which enables more accurate tumor identification, characterization and staging. Contrast agents are widely used in clinical magnetic resonance imaging; approximately 40-50% of clinical scans are contrast enhanced. Most contrast agents are based on the paramagnetic gadolinium ion Gd3+, which is chelated to avoid the toxic effects of free gadolinium. Multiple factors such as molecule structure, molecule concentration, dose, field strength and temperature determine the longitudinal and transverse relaxation rates (R1 and R2, respectively) and thus the T1- and T2-relaxivities of these chelates. These T1- and T2-relaxivities, together with their pharmacokinetic properties (i.e. distribution and concentration in the area of interest), determine the radiologic efficacy of the gadolinium-based contrast agents.
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Affiliation(s)
- Giovanni Morana
- Radiological Department, General Hospital Ca' Foncello, Treviso, Italy
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Pharmacokinetic Approach for Dynamic Breast MRI to Indicate Signal Intensity Time Curves of Benign and Malignant Lesions by Using the Tumor Flow Residence Time. Invest Radiol 2013; 48:69-78. [DOI: 10.1097/rli.0b013e31827d29cf] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Vignati A, Giannini V, De Luca M, Morra L, Persano D, Carbonaro LA, Bertotto I, Martincich L, Regge D, Bert A, Sardanelli F. Performance of a fully automatic lesion detection system for breast DCE-MRI. J Magn Reson Imaging 2011; 34:1341-51. [PMID: 21965159 DOI: 10.1002/jmri.22680] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 05/23/2011] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe and test a new fully automatic lesion detection system for breast DCE-MRI. MATERIALS AND METHODS Studies were collected from two institutions adopting different DCE-MRI sequences, one with and the other one without fat-saturation. The detection pipeline consists of (i) breast segmentation, to identify breast size and location; (ii) registration, to correct for patient movements; (iii) lesion detection, to extract contrast-enhanced regions using a new normalization technique based on the contrast-uptake of mammary vessels; (iv) false positive (FP) reduction, to exclude contrast-enhanced regions other than lesions. Detection rate (number of system-detected malignant and benign lesions over the total number of lesions) and sensitivity (system-detected malignant lesions over the total number of malignant lesions) were assessed. The number of FPs was also assessed. RESULTS Forty-eight studies with 12 benign and 53 malignant lesions were evaluated. Median lesion diameter was 6 mm (range, 5-15 mm) for benign and 26 mm (range, 5-75 mm) for malignant lesions. Detection rate was 58/65 (89%; 95% confidence interval [CI] 79%-95%) and sensitivity was 52/53 (98%; 95% CI 90%-99%). Mammary median FPs per breast was 4 (1st-3rd quartiles 3-7.25). CONCLUSION The system showed promising results on MR datasets obtained from different scanners producing fat-sat or non-fat-sat images with variable temporal and spatial resolution and could potentially be used for early diagnosis and staging of breast cancer to reduce reading time and to improve lesion detection. Further evaluation is needed before it may be used in clinical practice.
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Affiliation(s)
- Anna Vignati
- Department of Radiology, IRCC - Institute for Cancer Research and Treatment, Candiolo, Italy.
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Evaluation of contrast-enhanced digital mammography. Eur J Radiol 2011; 78:112-21. [DOI: 10.1016/j.ejrad.2009.10.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 08/14/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
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Dietzel M, Baltzer PAT, Vag T, Herzog A, Gajda M, Camara O, Kaiser WA. The necrosis sign in magnetic resonance-mammography: diagnostic accuracy in 1,084 histologically verified breast lesions. Breast J 2011; 16:603-8. [PMID: 21070437 DOI: 10.1111/j.1524-4741.2010.00982.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Necrosis sign (NS) is a new descriptor for differential diagnosis of breast lesions in magnetic resonance (MR)-mammography (MRM). This study was designed: (a) to analyze diagnostic accuracy of NS in 1,084 histologically verified breast lesions, (b) to assess performance of NS in subgroups. This study was approved by the local ethical committee. All histologically verified lesions having undergone MR-mammography at our institution over 12 years were evaluated by experienced radiologists (> 500 MRM) according to standard protocols and study design (T1w; 0.1 mmol/kg bw gadolinium diethylenetriamine penta-acetic acid; T2-turbo spin echo (TSE)). Patients with history of breast biopsy (surgically, minimal-invasive), radiation- or chemotherapy ≤ 1 year before MRM were excluded. NS was assessed on T2w-TSE sequences and was rated positive if a hyperintense center in a hypointense lesion could be visualized (chi-squared test). One thousand and eighty-four lesions were available for statistical analysis (648: malignant, 436: benign). NS was significantly associated with malignancy (p < 0.001), providing specificity and positive predictive value (PPV) of 96.1% and 78.8%. Malignant lesions > 20 mm presented significantly more often NS (p < 0.001) than neoplasias ≤ 20 mm. There was no difference regarding prevalence of NS in small versus advanced benign lesions (n.s.), leading to better performance of NS in lesions > 20 mm (PPV: 87.8%). Correlation between NS and Grading of invasive carcinomas was significant. In this study of 1,084 lesions necrosis sign was a specific and highly predictive feature for differential diagnosis in MRM (Specificity: 96.1%; PPV: 78.8%). This particularly counts for advanced lesions (PPV 87.8%). As this new descriptor correlates with Grading, it could be used as an initial estimate of patient's prognosis.
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Affiliation(s)
- Matthias Dietzel
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Germany.
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Luciani ML, Pediconi F, Telesca M, Vasselli F, Casali V, Miglio E, Passariello R, Catalano C. Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound. Radiol Med 2011; 116:886-904. [PMID: 21293943 DOI: 10.1007/s11547-011-0630-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 07/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI). MATERIALS AND METHODS Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up. RESULTS Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered. CONCLUSIONS Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.
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Affiliation(s)
- M L Luciani
- Department of Radiological Sciences, University of Rome "La Sapienza", V.le Regina Elena 324, 00161 Rome, Italy.
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Intraindividual In Vivo Comparison of Gadolinium Contrast Agents for Pharmacokinetic Analysis Using Dynamic Contrast Enhanced Magnetic Resonance Imaging. Invest Radiol 2010; 45:233-44. [DOI: 10.1097/rli.0b013e3181d54507] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Handling a High Relaxivity Contrast Material for Dynamic Breast MR Imaging Using Higher Thresholds for the Initial Enhancement. Invest Radiol 2010; 45:114-20. [DOI: 10.1097/rli.0b013e3181cc2929] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dietzel M, Baltzer PAT, Vag T, Herzog A, Gajda M, Camara O, Kaiser WA. The adjacent vessel sign on breast MRI: new data and a subgroup analysis for 1,084 histologically verified cases. Korean J Radiol 2010; 11:178-86. [PMID: 20191065 PMCID: PMC2827781 DOI: 10.3348/kjr.2010.11.2.178] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 11/02/2009] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The adjacent vessel sign (AVS) is a descriptor for differentiating malignant from benign breast lesions on breast MRI (bMRI). This investigation was designed to verify the previous reports on the diagnostic accuracy of AVS and to assess correlation between AVS, histopathological diagnosis, lesion size and lesion grade. MATERIALS AND METHODS This study was approved by the local ethical committee. Experienced radiologists evaluated 1,084 lesions. The exclusion criteria were no histological verification after bMRI and breast interventions that were done up to one year before bMRI (surgery, core biopsy, chemo- or radiation therapy). The native and dynamic contrast-enhanced T1-weighted series were acquired using standardized protocols. The AVS was rated positive if a vessel leading to a lesion could be visualized. Prevalence of an AVS was correlated with the lesions' size, grade and histology using Chi-square-tests. RESULTS The AVS was significantly associated with malignancy (p < 0.001; sensitivity: 47%, specificity: 88%, positive-predictive-value [PPV]: 85%). Malignant lesions > 2 cm more often presented with an AVS than did those malignant lesions < 2 cm (p < 0.0001; sensitivity: 65%, PPV: 90%). There was no correlation of the AVS with the tumor grade. The prevalence of an AVS didn't significantly differ between invasive lobular carcinomas versus ductal carcinomas. In situ cancers were less frequently associated with an AVS (p < 0.001). CONCLUSION The adjacent vessel sign was significantly associated with malignancy. Thus, it can be used to accurately assess breast lesions on bMRI. In this study, the AVS was particularly associated with advanced and invasive carcinomas.
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Affiliation(s)
- Matthias Dietzel
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany.
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The challenge of imaging dense breast parenchyma: is magnetic resonance mammography the technique of choice? A comparative study with x-ray mammography and whole-breast ultrasound. Invest Radiol 2009; 44:412-21. [PMID: 19448554 DOI: 10.1097/rli.0b013e3181a53654] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To establish the value of magnetic resonance imaging (MRI) of the breast in comparison to x-ray mammography and ultrasound for breast cancer evaluation in women with dense breast parenchyma. MATERIALS AND METHODS Two hundred thirty-eight women with dense breast parenchyma who were suspicious for breast cancer or inconclusive for the presence of breast lesions based on clinical examination, ultrasound or x-ray mammography, and who underwent breast MRI at 1.5 T before and after administration of 0.1 mmol/kg gadobenate dimeglumine were evaluated. Lesions considered malignant (Breast Imaging Reporting and Data System (BI-RADS) 4 or 5) on x-ray mammography and/or ultrasound and as BI-RADS 3, 4, or 5 on MRI were evaluated histologically. Other lesions were followed up at 6 and/or 18 months. The diagnostic performance (sensitivity, specificity, accuracy, and positive and negative predictive values) of each technique was determined and compared using a general linear mixed model with appropriate correction for multiplicity. RESULTS At final diagnosis 121 of 238 (50.8%) women had one or more confirmed malignant lesions, whereas 117 (49.2%) had benign lesions or no lesions. Among 97 women who underwent all 3 techniques more lesions (malignant and benign) were detected with breast MRI (n = 135) than with x-ray mammography (n = 85) or ultrasound (n = 107) and diagnostic confidence was greater. In terms of patient-based diagnostic accuracy breast MRI was significantly (P[r] < 0.0001) superior to both x-ray mammography and ultrasound (96.9% accuracy for MRI vs. 60.8% for mammography and 66.0% for US). Malignant lesions were histologically confirmed in 55 of 97 women who underwent all 3 techniques. Breast MRI detected more cases of multifocal, multicentric, and contralateral disease and fewer misdiagnoses occurred. Overall, breast MRI led to a modification of the surgical approach for 28 (23.1%) of the 121 women with diagnosed malignant disease. CONCLUSION Breast MRI should be considered for routine breast cancer evaluation in women with dense breast parenchyma.
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Contrast-enhanced breast MR imaging of claustrophobic or oversized patients using an open low-field magnet. Radiol Med 2009; 114:267-85. [DOI: 10.1007/s11547-008-0358-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Accepted: 08/07/2008] [Indexed: 11/27/2022]
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Abstract
Current advances in magnetic resonance, as a diagnostic modality, are discussed in the context of publications from Investigative Radiology during 2007 and 2008. The articles relating to this topic, published during the past 2 years, are reviewed by anatomic region. The discussion concludes with a consideration of magnetic resonance contrast media, focusing on studies published in the journal, and examining in particular the potential impact of nephrogenic systemic fibrosis.
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Intra-individual Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine for Contrast-Enhanced Magnetic Resonance Angiography of the Supraaortic Vessels at 3 Tesla. Invest Radiol 2008; 43:695-702. [DOI: 10.1097/rli.0b013e31817d1505] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evaluation of lesions of uncertain malignant potential (B3) at core needle biopsy using magnetic resonance imaging: A new approach warrants prospective studies. Breast 2008; 17:117-9. [DOI: 10.1016/j.breast.2008.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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