Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps

Nissan, Noam; Allweis, Tanir; Menes, Tehillah S.; Brodsky, Asia; Paluch‐Shimon, Shani; Haas, Ilana; Golan, Orit; Miller, Yaheli; Barlev, Hani; Carmon, Einat; Brodsky, Malka; Anaby, Debbie; Lawson, Philip; Halshtok-Neiman, Osnat; Shalmon, Anat; Gotlieb, Michael; Faermann, Renata; Konen, Eli; Sklair‐Levy, Miri

doi:10.1007/s00330-019-06435-x

Cited by 26 publications

(13 citation statements)

References 39 publications

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“…DCE was acquired prior to and four times after an automated injection of contrast agent bolus [0.1 ml/kg at 2 ml/sec Dotarem, (gadoterate meglumine, Guerbet)] followed by a 20-ml saline flush. Post-contrast images were acquired, with the first acquisition centered at 1:25 minutes after injection and the delayed acquisition centered at 7:35 minutes after injection, as was previously described [11] .…”

Section: Methodsmentioning

confidence: 99%

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

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Introduction: Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. Materials and Methods: Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients’ and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. Results: Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA -carriers. During the study, number of detected lymphadenopathies increased by 394% (p=0.00001) in comparison with previous two consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5±2 mm. Longer lymph-node diameter after second vaccination was noted (from 15±5 mm, to 18±6 mm, p=0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p=0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p=0.007). Lymphadenopathy was evident on mammography in only 49% of cases. Discussion: Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA -carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.

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Section: Methodsmentioning

confidence: 99%

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

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“…For this reason, linear nonionic contrasts retain more gadolinium than linear ionic, and linear ionic more than macrocyclic contrasts. [14][15][16] A recent trend to utilize gadolinium-free MRI techniques in clinical scenarios where use of GBCA is a challenge, like pregnancy, severe contrast allergies, and lactational status [17][18][19] rely on Diffusion-(GBCA-free)-MRI techniques (DWI/DTI-MRI) that are based on the intrinsic cellular contrast. [20][21][22][23][24][25][26] Certain breast Diffusion-MRI protocols have also been used for high-risk screening and as a problem-solving tool in selected cases, 27,28 however it should not be used as stand-alone technique yet, as clinical protocols are still under evaluation.…”

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confidence: 99%

What’s Hot in Breast MRI

Scaranelo

2021

Can Assoc Radiol J

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Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.

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“…The characteristic marked lactationinduced BPE on DCE-MRI, stemmed by the temporal increased vascular supply and permeability (25), causes diagnostic challenge in distinguishing between lactation-related changes and suspicious findings (14À17). Instead, unenhanced diffusion-based MRI approaches that were gaining success as alternative for DCE (28,29), were also attempted for characterization of the healthy lactating breast parenchyma (30À34), as well as for preliminary inquiries among PABC patients (16,35).…”

Section: Discussionmentioning

confidence: 99%

“…The lactating breast is characterized by a rich vasculature network (13) and typically displays a prominent background enhancement (BPE) on DCE MRI (14À17). Lactationinduced BPE may markedly reduce the conspicuity of coexistent tumor (18), therefore imposing a diagnostic complexity in discriminating between physiological and pathological findings, including the often delayed diagnosis of pregnancyassociated breast cancer (PABC) (16). Consequently, the use of DCE MRI during lactation has been debated (19).…”

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MRI of the Lactating Breast: Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features

et al. 2022

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Rationale and Objectives: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. Materials and Methods:The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automaticallyobtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups' trends and differences between the lactating and cancer cohorts were statistically assessed.Results: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001).Conclusion: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.

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Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps

Cited by 26 publications

References 39 publications

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

What’s Hot in Breast MRI

MRI of the Lactating Breast: Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features

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