The Lactating Breast: Contrast-enhanced MR Imaging of Normal Tissue and Cancer 1

Stanford University, Palo Alto, California, United States
Radiology (Impact Factor: 6.87). 12/2005; 237(2):429-36. DOI: 10.1148/radiol.2372040837
Source: PubMed


To retrospectively describe the magnetic resonance (MR) imaging characteristics of normal breast tissue and breast cancer in the setting of lactation.
The HIPAA-compliant study was exempt from institutional approval, and informed consent was not required. Unilateral MR imaging of 10 breasts was performed in seven lactating patients aged 27-42 years. For the three patients in whom both breasts were imaged, each breast was imaged on a separate day. Nonenhanced T1-weighted and fat-saturated T2-weighted images and contrast material-enhanced dynamic three-dimensional (3D) T1-weighted spiral gradient-echo images interleaved with T1-weighted high-spatial-resolution 3D gradient-echo images (2.0 x 1.0 x 0.4-mm voxels) were obtained. Three readers in consensus assessed the glandular density, T2-weighted signal intensity, milk duct appearance, and contrast enhancement in normal and tumor-containing breast regions. The pharmacokinetic contrast enhancement parameters of tumors were compared with those of normal tissue by using Student t and Mann-Whitney tests.
MR findings of normal breast tissue in the seven women included increased glandular density in six women, high T2-weighted signal intensity in six, dilated central ducts in seven, and rapid initial glandular contrast enhancement in seven. MR findings of invasive ductal carcinoma in five women, compared with findings of the normal glandular tissue, included lower T2-weighted signal intensity in five women, more avid and rapid contrast enhancement in five, and early contrast enhancement washout in four. One minute after contrast agent injection, tumor signal intensity increased significantly more than normal lactating tissue signal intensity (153% vs 60% from baseline, P = .016). The median two-compartment model K(21) exchange rate in the tumors, 0.078 sec(-1), was significantly faster than the K(21) exchange rate in normal tissue, 0.011 sec(-1) (P = .03).
Normal lactating glands have increased density, high T2-weighted signal intensity, and rapid moderate contrast enhancement. Breast cancers are visible during lactation owing to their lower signal intensity and more intense initial contrast enhancement with early washout compared with normal breast tissue.

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    • "Lactating breast tissue has a uniformly long T2, resulting in diffuse high signal intensity on T2-weighted MR images. Normal lactating tissue shows rapid enhancement followed by an early plateau of enhancement, unlike normal non-lactating breast tissue, which shows mild and progressive enhancement [14] (Fig. 2). Breast cancers are visible during lactation owing to their lower signal intensity on T2-weighted images and more intense initial contrast enhancement with early washout compared with normal breast tissue [14] (Fig. 3), though some authors report an overlap of enhancement characteristics of invasive cancer with that of the lactating tissue, attributed to increased vascular permeability [15] (Fig. 4). "
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    ABSTRACT: Substantial physiological changes occur during pregnancy and lactation, making breast evaluation challenging in these patients. This article reviews the imaging challenges of the breast during pregnancy and lactation. The normal imaging appearance, imaging protocols and the imaging features of each commonly encountered benign and malignant entity with pathological correlation and supporting examples is described. An awareness of the imaging features of the breast during these physiological states and of various benign and malignant diseases that occur permits optimal management. Evaluation of the pregnant and lactating patients who present with a breast problem is challenging. Although ultrasound may characterise the finding in many cases, mammography and even MRI may have a role in the management of these patients. • To review physiological changes of the breast during pregnancy and lactation • To review imaging protocols of the breast during pregnancy and lactation • Discuss imaging findings with pathological correlation of benign and malignant diseases in pregnancy and lactation • Discuss pathological correlation of imaging findings in pregnancy and lactation.
    Full-text · Article · Jul 2013 · Insights into Imaging
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    • "To date both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) have had little to offer in elucidating pathology in the lactating breast. A recent report using MRI illustrated a duct after its injection with contrast [4] and another demonstrated dilated ducts and a high proportion of glandular tissue in seven lactating women [5]. However it is likely these modalities may provide much more useful information in the future. "
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    ABSTRACT: Ultrasound imaging has been used extensively to detect abnormalities of the non-lactating breast. In contrast, the use of ultrasound for the investigation of pathology of the lactating breast is limited. Recent studies have re-examined the anatomy of the lactating breast highlighting features unique to this phase of breast development. These features should be taken into consideration along with knowledge of common lactation pathologies in order to make an accurate diagnosis when examining the lactating breast. Scanning techniques and ultrasound appearances of the normal lactating breast will be contrasted to those of the non-lactating breast. In addition ultrasound characteristics of common pathologies encountered during lactation will be described.
    Full-text · Article · May 2009 · International Breastfeeding Journal

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