Gadolinium-enhanced MR angiography of the breast: Is breast cancer associated with ipsilateral higher vascularity?

Abstract

The aim of this study was to assess a possible association between breast malignancy and ipsilateral higher vascularity on gadolinium-enhanced MR angiography. One hundred six patients were examined by dynamic gadolinium-enhanced 3D MR imaging. Magnetic resonance angiographic views were generated by image subtraction and maximum intensity projection. The study included 85 patients with unilateral malignant breast neoplasms and 21 with unilateral benign lesions. Three blinded readers independently reviewed the MR angiograms after masking the lesions and the corresponding contralateral sites. The readers were asked to determine whether vascularity was higher on the right side, higher on the left side, or equal on both sides. The results were analyzed by the Kappa statistic and Pearson's chi-square test. The blood vessels of the breasts were clearly seen in all cases. There was good agreement among the observers (kappa > 0.54) in assessing vascularity on both sides. Breasts harboring malignant neoplasms were found to have a higher vascularity than the contralateral breasts (p < 0.005). This sign of malignancy had a sensitivity of 76.5%, a specificity of 57%, and an accuracy of 72.6%. Blood vessels of the breast can be depicted by MR angiography. Unilateral malignant neoplasms are associated with a higher ipsilateral vascularity. In conjunction with other indications of malignancy on gadolinium-enhanced MR images, a higher ipsilateral vascularity may serve as an additional sign of malignancy.

Correlation of Whole-Breast Vascularity with Ipsilateral Breast Cancers Using Contrast-Enhanced MDCT

“…MRI also enables assessment of ipsilateral vascularity as a whole and observation of increased vascularity in cancerbearing breasts, which could be used as a sign of malignancy [17][18][19]. Mahfouz et al [18] showed an association between breast cancer and a higher ipsilateral vascularity; however, the sensitivity and specificity of this sign for the diagnosis of malignancy were only 76.5% and 57%, respectively. Sardanelli et al [17] suggest that vascular asymmetry could be considered a potential MRI sign of invasive breast cancer, with sensitivity and specificity of 88% and 82%, respectively.…”

“…Although ipsilateral increased vascularity is frequently associated with ipsilateral invasive breast cancer, the question of whether this finding is clinically valuable remains largely unanswered. Indeed, intermediate sensitivity and specificity, which have been described in earlier MRI studies, make it less reliable in individual patients [17,18]. Therefore, additional study should be focused on differentiation of benign breast lesions or no lesions.…”

“…However, vascularity can increase not only within a breast cancer lesion but also in the ipsilateral breast as a whole. Recently, some studies have estimated whole-breast vascularity by laser Doppler perfusion imaging [15], PET [16], and MRI [17][18][19] and found an association between breast cancer and an ipsilateral increase of blood flow.Although contrast-enhanced CT of the breast has been used for assessment of axillary lymph node metastasis [20,21], diagnosis of local recurrence after breast-conserving surgery [22], or imaging intraductal extension of breast cancer preoperatively [23], it can also show tumor vascularity. Especially, MDCT can display high-quality angiographic images because of improved temporal and spatial resolution.…”

“…However, vascularity can increase not only within a breast cancer lesion but also in the ipsilateral breast as a whole. Recently, some studies have estimated whole-breast vascularity by laser Doppler perfusion imaging [15], PET [16], and MRI [17][18][19] and found an association between breast cancer and an ipsilateral increase of blood flow.…”

A new algorithm for automatic vascular mapping of DCE-MRI of the breast: Clinical application of a potential new biomarker

“…In addition, some reports suggest that preoperative breast MRI in women with newly diagnosed cancer could potentially increase the rate of unnecessary biopsies and surgery [2]. Recent studies aimed to increase the specificity of breast DCE-MRI by adding a vessel analysis to the standard morphologic and kinetic criteria, therefore exploring the diagnostic value of vascularity [7][8][9]. During the past decade, this research issue has been approached in two ways: first, whole-breast vascularity, and second, local vascularity, that is, vessels adjacent to and feeding a lesion or lesions [9].…”