With proper parameters, TWIST-Dixon provides higher perceived SNR, more accurate fat suppression, and better overall image quality for breast DCE-MRI without sacrificing accuracy in the enhancement estimation.
Robust and accurate fat suppression is highly desirable in breast magnetic resonance imaging (MRI) because it can considerably improve the image quality and lesion conspicuity. However, fat suppression is also more challenging in the breast compared with other regions in the body. Technical advances have been made over time to make fat suppression more efficient and reliable. Combined with other innovations, breast MRI continues to be the most sensitive and comprehensive diagnostic modality in the detection and evaluation of breast lesions. This review offers a critical comparison of various fat suppression techniques in breast MRI including spectral-selective excitation and saturation techniques based on the chemical shift difference between fat and water, the inversion recovery techniques based on the T1 relaxation time difference, the hybrid spectral-selective inversion recovery techniques, and the new Dixon fat and water separation techniques based on the phase difference between fat and water signal at different echo times. This review will also cover less frequently used techniques such as slice-selective gradient reversal. For each fat suppression technique in breast MRI, a detailed explanation of the technical principle, the advantages and disadvantages, the approaches for optimization as well as the clinical examples are included. The additional challenges of fat suppression in breast MRI at higher field strength and in the presence of metallic and silicone implants are also discussed.
Metal implants introduce artifacts of different types and sizes, according to the different fat-suppression techniques used. The dual-echo Dixon technique produces a larger central void, allowing the implant to be easily identified, but presents a smaller overall artifact volume by obscuring less area in the image, according to a quantitative phantom study.
Objective
Digital breast tomosynthesis (DBT) has significantly improved cancer detection capabilities through its identification of subtle findings often imperceptible on 2D digital mammography, particularly architectural distortion (AD). The purpose of this study was to analyze of suspicious AD detected on screening DBT to evaluate the incidence of malignancy and to determine other patient or imaging characteristics in these cases as possible predictors of malignancy.
Methods
This was an IRB approved retrospective analysis of subjects with AD detected on DBT screening mammography who were given a biopsy recommendation between January 1, 2016, and June 30, 2018. Univariate analysis of various imaging characteristics and patient high-risk factors was performed for statistical correlation with diagnosis of malignancy.
Results
In the 218 DBT-detected AD findings with a final BI-RADS assessment of 4 or 5 on diagnostic workup, 94 (43.1%) yielded malignancy, 57 (26.2%) were classified as high-risk, and 67 (30.7%) were benign. There was a strong statistically significant association with malignancy in the cases with an US correlate (P < 0.0001). There was a statistically significant inverse correlation between malignancy and one-view findings (P = 0.0002). The presence of AD on 2D (P = 0.005) or synthetic 2D views (P = 0.002) showed statistically significant correlations with malignancy, whereas breast density or high-risk factors (P = 0.316) did not.
Conclusion
AD detected on DBT that persists on further workup and has no explainable cause should be considered suspicious for malignancy. Identification of the AD on both standard mammographic views and the presence of an US correlate significantly increase the probability of malignancy.
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