MR imaging of mammographically detected clustered microcalcifications: is there any value?

Westerhof, J P; Fischer, Uwe; Moritz, J.; Oestmann, J W

doi:10.1148/radiology.207.3.9609890

Cited by 93 publications

(63 citation statements)

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“…Because DCIS is the earliest stage of breast cancer and has the best prognosis, it is likely that further improvements in the detection of breast cancers at a preinvasive stage may improve patient outcomes. Some reports have shown decreased diagnostic accuracy of DCE MR imaging for DCIS (2,3), while others have shown comparable or even higher performance compared with that of x-ray mammography (4,5). The sensitivity of DCE MR imaging for detection of DCIS may be compromised if the lesion does not exhibit sufficient gadolinium uptake or if it is obscured by strongly enhancing parenchyma (6,7).…”

Section: C3mentioning

confidence: 99%

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Jansen¹,

Paunesku²,

Fan³

et al. 2009

Radiology

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Purpose:To combine dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with x-ray fluorescence microscopy (XFM) of mammary gland tissue samples from mice to identify the spatial distribution of gadolinium after intravenous injection. Materials and Methods:C3(1) Sv-40 large T antigen transgenic mice (n ϭ 23) were studied with institutional animal care and use committee approval. Twelve mice underwent DCE MR imaging after injection of gadodiamide, and gadolinium concentrationtime curves were fit to a two-compartment pharmacokinetic model with the following parameters: transfer constant (K trans ) and volume of extravascular extracellular space per unit volume of tissue (v e ). Eleven mice received gadodiamide before XFM. These mice were sacrificed 2 minutes after injection, and frozen slices containing ducts distended with murine ductal carcinoma in situ (DCIS) were prepared for XFM. One mouse received saline and served as the control animal. Elemental gadolinium concentrations were measured in and around the ducts with DCIS. Hematoxylin-eosin-stained slices of mammary tissues were obtained after DCE MR imaging and XFM. Results:Ducts containing DCIS were unambiguously identified on MR images. DCE MR imaging revealed gadolinium uptake along the length of ducts with DCIS, with an average K trans of 0.21 min Ϫ1 Ϯ 0.14 (standard deviation) and an average v e of 0.40 Ϯ 0.16. XFM revealed gadolinium uptake inside ducts with DCIS, with an average concentration of 0.475 mmol/L Ϯ 0.380; the corresponding value for DCE MR imaging was 0.30 mmol/L Ϯ 0.13. Conclusion:These results provide insight into the physiologic basis of contrast enhancement of DCIS lesions on DCE MR images: Gadolinium penetrates and collects inside neoplastic ducts. RSNA, 2009 Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.T he sensitivity and specificity of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging in the early detection of invasive cancers have been shown to be equal or superior to those of x-ray mammography (1). However, this has not been consistently demonstrated for ductal carcinoma in situ (DCIS), which is a nonobligate precursor to invasive breast cancer, in which cancer cells are still confined by the basement membrane of mammary ducts. Because DCIS is the earliest stage of breast cancer and has the best prognosis, it is likely that further improvements in the detection of breast cancers at a preinvasive stage may improve patient outcomes. Some reports have shown decreased diagnostic accuracy of DCE MR imaging for DCIS (2,3), while others have shown comparable or even higher performance compared with that of x-ray mammography (4,5). The sensitivity of DCE MR imaging for detection of DCIS may be compromised if the lesion does not exhibit sufficient gadolinium uptake or if it is obscured by strongly enhancing parenchyma (6,7). Even when D...

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Section: C3mentioning

confidence: 99%

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Jansen¹,

Paunesku²,

Fan³

et al. 2009

Radiology

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“…Other MR studies have reported variable accuracy for classification of microcalcification. Westerhof et al (1998), investigating mammographically suspicious microcalcifications, reported a sensitivity of 45%, specificity of 72%, positive predictive value of 71%, negative predictive value 46% and an accuracy of 56%, and in a further study, Gilles et al observed a sensitivity of 95% and a specificity of 51%. Their specificity was impaired because the presence or absence of contrast uptake in the breast was the only parameter used to decide if the area of microcalcification was associated with malignancy or not (Gilles et al, 1996).…”

Section: Dcismentioning

confidence: 93%

Current applications and future direction of MR mammography

2003

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Compared with triple assessment for symptomatic and occult breast disease, magnetic resonance mammography (MRM) offers higher sensitivity for the detection of multifocal cancer, which is important in selecting patients appropriately for breast-conserving surgery. It is an ideal tool for the screening of patients with a high risk of breast cancer or where there is axillary disease or nipple discharge and conventional imaging has not revealed the primary focus. Techniques are now available to biopsy lesions only apparent on MRM. MRM can differentiate scar tissue from tumour; therefore, it is useful in patients in which there is possible recurrent disease. Clinical and X-ray mammographic assessment of response to neoadjuvant chemotherapy may be unreliable because of replacement of the tumour with scar tissue. MRM can identify responders and nonresponders with more accuracy. It is the modality of choice for the assessment of breast implants for rupture with accuracy higher than X-ray mammography and ultrasound. Advances in both spatial and temporal resolutions, the imaging sequences employed, pharmacokinetic modelling of contrast uptake, the use of dedicated and now phased-array breast coils, and gadolinium-based contrast agents have all played their part in the advancement of this imaging technique. Despite the limitations of patient compliance, scan-time and cost, this review describes how MRM has become a valuable tool in breast disease, especially in cases of diagnostic uncertainty. However, MRM must make the transition from research institutions into routine clinical practice.

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“…Reports on the usefulness of MRI for the evaluation of calcified lesions began to appear in the late 1990s, but as the ability of MRI in the qualitative diagnosis of calcified lesions was insufficient, the benefit of MRI was refuted [142]. In the 2000s, the diagnostic ability of MRI was improved due to technical developments, and the recent changes in the clinical procedures associated with the introduction of SVAB have led to increases in reports recommending MRI [143][144][145].…”

Section: Commentsmentioning

confidence: 99%

The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline

et al. 2015

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Diagnostic imaging is undoubtedly important in modern medicine, and final clinical decisions are often made based on it. Fortunately, Japan has the highest numbers of diagnostic imaging instruments, such as CT and MRI devices, and boasts easy access to them as well as a high level of diagnostic accuracy. In consequence, a very large number of imaging examinations are performed, but diagnostic instruments are installed in so many medical facilities that expert management of these examinations tends to be insufficient. Particularly, in order to avoid risks, clinicians have recently become indifferent to indications of imaging modalities and tend to rely on CT or MRI resulting in increasing the number of imaging examinations in Japan. This is a serious problem from the viewpoints of avoidance of unnecessary exposure and medical economy. Under these circumstances, the Japan Radiological Society and Japanese College of Radiology jointly initiated the preparation of new guidelines for diagnostic imaging. However, the field of diagnostic imaging is extremely wide, and it is impossible to cover all diseases. Therefore, in drafting the guidelines, we selected important diseases and focused on ''showing evidence and suggestions in the form of clinical questions (CQs)'' concerning clinically encountered questions and ''describing routine imagingThe Japan Radiological Society/Japanese College of Radiology Imaging Guideline was published in 2013.The homepage of the Japan Radiological Society contains information about all CQs of the Japanese Imaging Guideline 2013 as an English version http://www.radiology.jp/english/guideline.html. Radiol (2016) 34:43-79 DOI 10.1007 techniques presently considered to be standards to guarantee the quality of imaging examinations''. In so doing, we adhered to the basic principles of assuming the readers to be ''radiologists specializing in diagnostic imaging'', ''simultaneously respecting the global standards and attending to the situation in Japan'', and ''making the guidelines consistent with those of other scientific societies related to imaging''. As a result, the guidelines became the largest ever, consisting of 152 CQs, nine areas of imaging techniques, and seven reviews, but no other guidelines in the world summarize problems concerning diagnostic imaging in the form of CQs. In this sense, the guidelines are considered to reflect the abilities of diagnostic radiologists in Japan. The contents of the guidelines are essential knowledge for radiologists, but we believe that they are also of use to general clinicians and clinical radiological technicians. While the number and contents of CQs are still insufficient, and while chapters such as those on imaging in children and emergency imaging need to be supplemented, the guidelines will be serially improved through future revisions. Lastly, we would like to extend our sincere thanks to the 153 members of the drafting committee who authored the guidelines, 12 committee chairpersons who coordinated their efforts, six members of the...

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MR imaging of mammographically detected clustered microcalcifications: is there any value?

Abstract: MR imaging of the breast is not reliable in differentiation of benign from malignant breast disease in mammographically suspicious clustered microcalcifications and has no effect on treatment.

Cited by 93 publications

References 0 publications

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Current applications and future direction of MR mammography

The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline

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