MR Imaging of the Breast for the Detection, Diagnosis, and Staging of Breast Cancer

Abstract

With the introduction of contrast agents, advances in surface coil technology, and development of new imaging protocols, contrast agent-enhanced magnetic resonance (MR) imaging has emerged as a promising modality for detection, diagnosis, and staging of breast cancer. The reported sensitivity of MR imaging for the visualization of invasive cancer has approached 100%. There are many examples in the literature of MR imaging--demonstrated mammographically, sonographically, and clinically occult breast cancer. Often, breast cancer detected on MR images has resulted in a change in patient care. Despite these results, there are many unresolved issues, including no defined standard technique for contrast-enhanced breast MR imaging, no standard interpretation criteria for evaluating such studies, no consensus on what constitutes clinically important enhancement, and no clearly defined clinical indications for the use of MR imaging. Furthermore, this technology remains costly, and issues of cost-effectiveness and cost competition from percutaneous biopsy have yet to be fully addressed. These factors along with the lack of commercially available MR imaging--guided localization and biopsy systems have slowed the transfer of this imaging technology from research centers to clinical breast imaging practices. Technical requirements, potential clinical applications, and potential pitfalls and limitations of contrast-enhanced MR imaging as a method to help detect, diagnose, and stage breast cancer will be described.

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

“…By repeating the examination of all premenopausal patients with intensive contrast enhancement in accordance with the menstrual cycle, the chance of detecting the malignancy would have been higher (Table 1, case 10,11), although this will not be achievable.…”

“…Apart from a higher breast density it appeared that, especially in BRCA1/2 mutation carriers, also a higher growth rate and aspecific mammographic characteristics of the tumors contribute to a lower sensitivity [4][5][6][7]. Because of the consistently high sensitivity of MRI of the breast in diagnostic settings, with values between 90 and 100% [8][9][10], the role of contrast-enhanced MRI of the breast in screening of high-risk women was investigated. The first results of screening high-risk women with MRI were promising: MRI detected cancers still occult at mammography and not yet clinical manifest [11][12][13][14].…”

Correlation of dynamic contrast enhancement MRI parameters with microvessel density and VEGF for assessment of angiogenesis in breast cancer

“…For detection of very small lesions, a fat-sat high spatial resolution imaging sequence may be preferred over the subtraction technique. Although the subtraction technique generally worked well, it is more susceptible to motion artifact and patient movement, which may obscure detection of very small lesions (40).…”

Model-free visualization of suspicious lesions in breast MRI based on supervised and unsupervised learning

“…Its update equation for the CVs can be derived from equation (2). The cooperativity function a i is given by (3) with ρ(t) being the time dependent "fuzzy range" of the model, which defines a length scale in X and which is annealed to repeatedly smaller values in the course of the training. In parlance of statistical mechanics, ρ represents the temperature T of a multiparticle system by T = 2ρ 2 .…”

“…Thus, early detection of breast cancer continues to be the key for effective treatment. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become a valuable tool for detection, diagnosis and management of breast cancer [1][2][3]. Yet, interpretation of the multitemporal 3D image data poses new challenges to radiologists.…”