Breast MR Imaging: Current Indications and Advanced Imaging Techniques
Section snippets
Background
The formation of neovascularity by the malignant tumor serves as the basis for breast cancer detection by MR imaging. With the use of gadolinium-based intravenous contrast agents, the sensitivity of MR imaging for invasive breast cancer approaches 100%. The neovasculature of cancers does not resemble blood vessels found in normal tissue or benign lesions. These new blood vessels have increased permeability (ie, “leakiness”) resulting in rapid tumor uptake of contrast and early enhancement on MR
Basic MR techniques for breast cancer imaging
Since the early development of breast MR imaging, numerous technical developments, variations, and innovations have been described and often debated. Given the dynamic nature of MR imaging technology and the rapid pace of advances in hardware and software, any description of standard breast MR imaging techniques or protocols is by nature a reflection of the current state of the technology and the science as applied by breast imagers. This section describes the basic features of a breast MR
Breast MR Imaging at 3 T
With the advent of 3-T imaging, many investigators began to explore the options that breast imaging at this higher field would allow. At present, all major vendors provide breast coils for use at 3 T, many of which have features such as multicoil arrangements that are optimized for parallel imaging. In general, the signal of MR imaging increases by the square of the field strength, while the noise increases linearly with field strength. Thus, 3-T breast MR imaging in theory provides twice the
Local Cancer Staging
One of the most common uses for MR imaging is in the patient with recent diagnosis of breast cancer. MR imaging has the ability to map primary tumor size, define unsuspected additional foci of tumor, and to screen for clinically occult cancer in the contralateral breast. MR imaging can better estimate primary tumor size,85 allowing for appropriate surgical planning. MR imaging is also better able than mammography to depict primary tumor margins in invasive lobular cancers,86 and can lower
High-risk breast screening by MR imaging
Whereas the lifetime risk of breast cancer for a woman is as high as 1 in 8, for a woman who is a genetic mutation carrier the lifetime risk can be as high as 80%.148, 149 In addition to a significantly higher lifetime risk, these women tend to develop more aggressive cancers at an earlier age. Multiple studies have reported mammographically occult breast cancer detected by MR imaging in high-risk populations.3, 14, 15, 16, 17, 18, 19, 20, 21, 150 Therefore, surveillance by MR imaging, as an
Breast MR imaging controversies
Criticisms about MR imaging include the potential high false-positive rate, leading to unnecessary biopsies, and the clinical relevance of the MR imaging–detected secondary cancers. There are many factors that contribute to the false-positive rate. One is the interobserver variability of readers interpreting MR imaging studies,152, 153 a finding also observed in mammogram interpretations.154 It is hoped that as experience with breast MR imaging increases, the false-positive rate will decrease.
Summary
Breast MR imaging has brought about a revolution in breast imaging, and continues to evolve and improve technically. From its nascent period when the first contrast-enhanced MR imaging was performed, breast MR imaging use has grown substantially, with multiple clinical scenarios whereby MR imaging is now routine for screening, diagnosis, or staging of disease. There are still limitations to the technology; it is expensive and not as widely available as mammography. Deficiencies with specificity
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Radioproteomics in Breast Cancer: Prediction of Ki-67 Expression With MRI-based Radiomic Models
2022, Academic RadiologyCitation Excerpt :Due to the increased permeability in the tumor tissue, dynamic contrast-enhanced images provide significant data about the morphological (tumor shape, size, extension), kinetic contrast agent uptake, angiogenesis, and prognostic features (type, grade) of the tumor (53–56). On the other hand, DWI is an imaging technique that evaluates the free movement of water molecules in the tissue, and the strength of the signal obtained from water molecules is proportional to the degree of diffusion, and the quantitative measurement of this diffusion degree creates ADC maps (57). Since the movement of water molecules is restricted in invasive BC, less ADC value is obtained compared to normal breast tissue (57,58).
Clinical PET-MR Imaging in Breast Cancer and Lung Cancer
2016, PET ClinicsCitation Excerpt :Precontrast and postcontrast T1-weighted images are obtained using a gradient echo technique. Detection of neoplasms within the breast is primarily achieved by evaluating the dynamic contrast enhancement of a lesion in which the variable uptake kinetics of contrast material help to distinguish malignant from benign lesions.25 Various other techniques have been used to improve the specificity of diagnosis, including the use of other imaging characteristics of a lesion.
Detection and diagnosis of breast lesions: Performance evaluation of digital breast tomosynthesis and magnetic resonance mammography
2016, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :MRI is not influenced by breast density. Therefore, it may help to characterize the lesion (5), and provide valuable information about breast cancer (4). After a very promising start of MR of the breast in the clinical practice, a variety of difficulties and obstacles were identified, for example: the lack of standardization of image acquisition, paucity of MR-compatible interventional devices, and the debate about its specificity and positive predictive value, and also its sensitivity for ductal carcinoma in situ (6).
Role of dynamic contrast enhanced MRI in evaluation of post-operative breast lesions
2016, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :Dynamic contrast-enhanced magnetic resonance imaging (DCE-MR) has been shown to aid significantly in detection and characterization of primary and recurrent breast cancers (4). The most important factor is that MRI can assess both lesion morphology and enhancement kinetics (5). The sensitivity of breast MR imaging for detection of residual and recurrent tumor in the post-breast conservative therapy (BCT) is over 90% (6).
Development and validation of a four-dimensional registration technique for DCE breast MRI
2023, Insights into ImagingMultiparametric MR Imaging Radiomics Signatures for Assessing the Recurrence Risk of ER+/HER2− Breast Cancer Quantified With 21-Gene Recurrence Score
2023, Journal of Magnetic Resonance Imaging