Abbreviated Breast Magnetic Resonance Imaging (MRI): First Postcontrast Subtracted Images and Maximum-Intensity Projection—A Novel Approach to Breast Cancer Screening With MRI

Kuhl, Christiane K.; Schrading, Simone; Strobel, Kevin; Schild, Hans H.; Hilgers, Ralf-Dieter; Bieling, Heribert

doi:10.1200/jco.2013.52.5386

Cited by 521 publications

(480 citation statements)

References 42 publications

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“…detailed morphologic lesion characterization [26]. For more detailed morphologic information, a high-resolution non-dynamic sequence could be added to the scan protocol.…”

Section: Discussionmentioning

confidence: 99%

“…With these criteria, breast MRI has a sensitivity of about 85 % to 99 % in detecting malignant breast lesions, as has been shown in several studies [1, 2, 16 -24]. Recently, the implementation of MRI exams in regular screening settings has been discussed as well [19,25,26]. If MRI of the breast is to be used under screening conditions, the shortening of protocols would be preferable.…”

Section: Introductionmentioning

confidence: 98%

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Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images

Wenkel

Janka

Geppert

et al. 2017

Fortschr Röntgenstr

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Purpose?The aim was to evaluate a minimum echo time (minTE) protocol for breast magnetic resonance imaging (MRI) in patients with breast lesions compared to a standard TE (nTE) time protocol. Methods?Breasts of 144 women were examined with a 1.5 Tesla MRI scanner. Additionally to the standard gradient-echo sequence with nTE (4.8?ms), a variant with minimum TE (1.2?ms) was used in an interleaved fashion which leads to a better temporal resolution and should reduce the scan time by approximately 50?%. Lesion sizes were measured and the signal-to-noise ratio (SNR) as well as the contrast-to-noise ratio (CNR) were calculated. Subjective confidence was evaluated using a 3-point scale before looking at the nTE sequences (1?=?very sure that I can identify a lesion and classify it, 2?=?quite sure that I can identify a lesion and classify it, 3?=?definitely want to see nTE for final assessment) and the subjective image quality of all examinations was evaluated using a four-grade scale (1?=?sharp, 2?=?slight blur, 3?=?moderate blur and 4?=?severe blur/not evaluable) for lesion and skin sharpness. Lesion morphology and contrast enhancement were also evaluated. Results?With minTE sequences, no lesion was rated with ?definitely want to see nTE sequences for final assessment?. The difference of the longitudinal and transverse diameter did not differ significantly (p?>?0.05). With minTE, lesions and skin were rated to be significantly more blurry (p?

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“…detailed morphologic lesion characterization [26]. For more detailed morphologic information, a high-resolution non-dynamic sequence could be added to the scan protocol.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images

Wenkel

Janka

Geppert

et al. 2017

Fortschr Röntgenstr

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“…Studies have shown that the sensitivity of MRI for breast cancer detection range from 91% -100%. [158][159][160][161] Supplemental MRI has been shown to improve diagnostic yield by 18.2% per 1000 women. 159 Importantly, MRI is very accurate in excluding the risk of tumour recurrence, with enhancement indicating risk of tumour recurrence and vice-versa.…”

Section: Imaging the Dense Breastmentioning

confidence: 99%

“…[158][159][160][161] Supplemental MRI has been shown to improve diagnostic yield by 18.2% per 1000 women. 159 Importantly, MRI is very accurate in excluding the risk of tumour recurrence, with enhancement indicating risk of tumour recurrence and vice-versa. [162][163][164] MRI has been shown to be the most accurate imaging modality for examination of the dense breast.…”

Section: Imaging the Dense Breastmentioning

confidence: 99%

Breast composition: Measurement and clinical use

Ekpo¹,

Hogg²,

Highnam³

et al. 2015

Radiography

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Breast density is a measure of the extent of radiodense fibroglandular tissue in the breast. The risk of developing breast cancer and the risk of missing cancer at screening rise with higher breast density. In this paper, the historical background to breast density measurement is outlined and current evidence based practice is explained. The relevance of breast density knowledge to mammographic practice and image interpretation is considered in the light of clinical assessment and notification of mammographic breast density (MBD). The current work also discusses risk stratification for decisionmaking regarding screening frequency and better modalities for earlier detection of breast cancer in the dense breast. Automated volumetric approaches are explained while ultrasound, digital breast tomosynthesis, molecular breast imaging, and magnetic resonance imaging are introduced as valuable adjuncts to digital mammography for imaging the dense breast. The work concludes on the important note that screened women should be notified of their breast density, and such notification should be accompanied with clear and adequate information about breast density and cancer risk, strategies associated with lower MBD, as well as best screening intervals and pathways for women with dense breasts. Adoption of these strategies may be crucial to early detection and treatment of cancer and improving survival from the disease.

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“…An abbreviated mri (abmri) screening protocol could therefore preferentially detect cancers that enhance rapidly and that might be biologically significant, while requiring decreased scan time [20][21][22] . To that end, a small but growing body of literature evaluating the efficacy of an abmri protocol is demonstrating consistently high sensitivity of abmri for malignancy [23][24][25] . Kuhl et al 26 reported a prospective study assessing the utility of an abbreviated protocol in more than 600 women, with the first post-contrast T1-weighted images and maximum intensity projections being used for interpretation.…”

mentioning

confidence: 99%

Utilization of Magnetic Resonance Imaging in Breast Cancer Screening

et al. 2015

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Early detection of malignancy through breast cancer screening has contributed significantly to the decline in cancer-related mortality 1 . The U.S. Preventive Services Task Force recently reaffirmed its 2009 stance to begin mammography-the primary screening modality-starting from age 50 and continuing until age 74 2 . However, that recommendation applies primarily to women at "average risk" for developing breast cancer during their lifetime. For women at "high risk," the American Cancer Society has recommended magnetic resonance imaging (mri) of the breast as an adjunct to annual screening mammography 3 . How, then, is risk defined, and should these guidelines be strictly followed by clinicians?Here, we focus first on describing the quality of mri as a screening tool. Then, we define risk categories and conclude with a discussion of the need for a more nuanced approach to the incorporation of mri into breast cancer screening.In prospective nonrandomized studies across multiple centres throughout the world, contrast-enhanced mri achieves a high sensitivity of 70%-100% in the initial screening (prevalence) setting, compared with 40% or less for mammography in patients at high risk for developing breast cancer [4][5][6] . The specificity of mri in that setting has been hampered by its difficulty in distinguishing the often overlapping features of benign and malignant lesions, causing higher false-positive rates 7 . It is important to note, however, that these oft-cited statistics actually improve significantly in the setting of subsequent (incidence) screening rounds. As noted by Warner et al. 6 , the rate of benign biopsy is reduced by nearly one half from the initial screening round to the second screening round (11% vs. 6.6%). In a study of mri screening in BRCA mutation carriers and women with high familial risk, Riedl et al. 8 highlighted the improvement in mri specificity from the first screening round to subsequent screening rounds. In addition, mri recall rates in their study declined dramatically from 26% on initial screening to 13% on second screening and 10% on third screening, emphasizing an improvement with successive rounds of screening. That finding was reinforced by Chiarelli and colleagues 9 in their report of the Ontario Breast Screening Program evaluating mri and mammography in high-risk women. Those authors observed lower recall rates with subsequent rounds of screening (when images from a baseline mri are available for comparison) and with increased experience of mri use at testing centres. As noted by Chiarelli et al., mri screening might be criticized for achieving lower positive predictive values, but two thirds of the cancers would be otherwise missed. Therefore, acceptance of a lower positive predictive value of mri screening in return for the gain of a higher detection rate must be considered. In addition, mri can offer an important contribution to the detection of ductal carcinoma in situ (dcis). Kuhl et al. 10 note that more than half of dcis lesions detected only by mri are histologic...

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Abbreviated Breast Magnetic Resonance Imaging (MRI): First Postcontrast Subtracted Images and Maximum-Intensity Projection—A Novel Approach to Breast Cancer Screening With MRI

Cited by 521 publications

References 42 publications

Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images

Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images

Breast composition: Measurement and clinical use

Utilization of Magnetic Resonance Imaging in Breast Cancer Screening

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