Direct MR Galactography: Feasibility Study

Abstract

MR galactography has the potential to be used in the diagnostic work-up of pathologic nipple discharge. Direct MR galactography shows more disease than does indirect MR galactography. The highest detection rate for ductal disease compared with that at conventional galactography was found with the direct MR galactography CISS and FLASH sequences.

Suspicious Nipple Discharge Diagnostic Evaluation

“…The rate of incomplete and/or technically inadequate conventional DG has been reported to be as high as 10-15% (Morrogh et al, 2008;Sickles, 2000). All of these technical difficulties may result in the failure to detect and surgically treat the lesion, as most cases of pathological ND have no detectable lump and negative or undefined ultrasonographic findings (Schwab et al, 2008).…”

“…Several approaches to MRI of the secreting breast have been suggested, including direct (Schwab, 2008;Wenkel, 2011) and indirect MRDG and fusion MR imaging of contrastenhanced and indirect ductography (Hirose et al, 2007).…”

“…Direct MRDG is performed by filling the discharging duct with gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA) diluted in saline, using a DG needle as for the conventional DG procedure, and obtaining 3D MRI sequences (Schwab et al, 2008). Schwab et al (2008) reported findings in 23 patients with pathological discharge.…”

“…Schwab et al (2008) reported findings in 23 patients with pathological discharge. Direct MRDG showed pathological findings in 82% of all findings, while indirect MRDG produced pathological findings in 33% of all findings with significant (p < 0.01) differences in the detection of ductal disease between indirect MRDG and all direct MRDG sequences.…”

“…Intraductal fluid accumulation and duct ectasia can be detected in 40-73% with patients with pathological ND (Daniel et al, 2003;Orel et al, 2000;Schwab et al, 2008), just as MR hydrography can noninvasively depict fluid-fluid tubular structures such as the bile and pancreatic ducts, the ureters, and the semicircular canals (Jara et al, 1998). This method, known as indirect MRDG, can demonstrate the peripheral part of the duct of the point obstructed by an intraductal lesion (Hirose et al, 2006).…”