Nuclear magnetic resonance in the diagnosis of breast cancer.
ABSTRACT We believe that the preponderance of evidence suggests that MRI is less accurate than conventional mammography in the diagnosis of primary cancer of the breast. Thus, it currently has no established place in algorithms for the evaluation of patients suspected of having breast cancer. MRI could be used to evaluate masses with mammographically smooth, well-defined margins, since high signal intensity (greater than fat) in a T2-weighted image is a highly specific indicator of benignancy in such lesions. However, most of these masses are cysts and can be reliably and less expensively identified as such by sonography. Nonetheless, MRI might be used to re-evaluate a smooth, well-defined mass if sonography has failed to identify the lesion as a cyst. MRI might be particularly useful in this regard if a lesion is difficult to evaluate by other modalities because it is located adjacent to the chest wall, is deep within a very large breast, or is obscured by a breast prosthesis. MRI with Gd-DTPA may be useful in evaluating radiographically dense breasts or in differentiating breast malignancies from irregular dysplastic or scar tissue. However, further investigation of this technique is needed. It has been hoped that in vivo measurement of T1 and T2 or in vivo NMR spectroscopy might improve the accuracy of noninvasive diagnosis of cancer of the breast. However, there is currently no credible evidence that in vivo measurements of relaxation times provide useful indexes for the diagnosis of breast cancer. In vivo NMR spectroscopy of nuclei other than P may ultimately provide reliable criteria for noninvasive diagnosis of breast cancer in humans, but the technique is currently in its infancy.
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ABSTRACT: To develop an optimized interpretation strategy of dynamic contrast enhanced breast MRI based on a combination of quantitative and qualitative criteria, the features of 120 histopathologically verified lesions were retrospectively analysed on contrast enhanced dynamically acquired (before and 1, 2, 4 and 7 min following injection of 0.2 mmol kg-1 gadolinium-DOTA) three-dimensional gradient echo images. Quantitative criteria, based on relative signal intensity measurements and qualitative morphological features, including lesion shape, margins and enhancement patterns were analysed in regard to differentiating malignant (n = 70) from benign (n = 50) lesions. Quantitative assessment of enhancement profiles was most accurate when analysis was based on early 1 min measurements. Using a 90% threshold, sensitivity and specificity in detecting breast cancer were 83% and 66%, respectively. When based on qualitative morphological analysis alone, sensitivity and specificity were 83% and 54%. Combined quantitative and qualitative assessment yielded a considerably higher sensitivity, specificity and accuracy of 93%, 74% and 85%, respectively. In conclusion, results from dynamic contrast enhanced breast MRI can be improved by basing the interpretation on both quantitative and qualitative criteria.British Journal of Radiology 06/1998; 71(845):501-9. · 1.22 Impact Factor
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ABSTRACT: Two patients who had received silicone injections in their breasts several years ago presented with breast complaints. Excluding cancer in these patients was very difficult. Mammograms were very difficult to interpret, as were the physical findings. Carcinoma was successfully detected by magnetic resonance imaging. When women who underwent the injudicious injection of silicone reach the cancer-prone age, the examining physicians should have a greater awareness of the detection and management of carcinoma coexistent with silicone mastopathy. We think that MRI is potentially valuable in the evaluation of the breast lesions; it plays an important role in the detection of breast cancer in breasts augmented with liquid silicone.Plastic & Reconstructive Surgery 01/2000; 104(7):2116-20. · 3.54 Impact Factor
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ABSTRACT: A dynamic contrast-enhanced MRI technique for whole breast examinations is presented. The fast kinetics of tissue response during and after constant-rate intravenous infusion of gadolinium diethylenetriaminopentaacetic acid was resolved using a strongly T1-weighted saturation recovery TurboFLASH sequence that makes it possible to acquire signal-time courses sequentially from 15 adjacent slices with a temporal sampling rate of 21 s. On the basis of the mathematically established and experimentally verified linear relationship between the measured saturation recovery TurboFLASH signal variation and the gadolinium diethylenetriaminopentaacetic acid concentration in the tissue, the signal-time courses were analyzed within the framework of pharmacokinetic modeling. In our study, the tissue response was parameterized adequately using an open linear two-compartment model. With this approach, the tissue specific information contained in the signal-time course can be described using only two parameters: an amplitude A, reflecting the degree of MR signal enhancement, and an exchange parameter k21, characterizing vascular permeability and perfusion of the tissue. A clearly arranged representation of the large amount of data (480 saturation recovery TurboFLASH breast images/examination) was accomplished by means of color coding of the computed parameters, resulting in one color-coded pharmacokinetic parameter map/cross-section.Magnetic Resonance in Medicine 05/1995; 33(4):506-14. · 3.27 Impact Factor