Multi-volume Fusion Imaging of MR Ductography and MR Mammography for Patients with Nipple Discharge

Abstract

Because nipple discharge is caused by carcinoma as well as benign disease, identification of intraductal abnormalities with ductography is important. Ductography is an invasive mammographic examination in which contrast material is injected directly into the duct. Failure to cannulate or extravasation may occur. Ductography shows evidence of lesions, such as filling defects, duct obstruction, or wall irregularity, but it does not reveal the lesion itself. Furthermore, ductography produces a two-dimensional image, so it does not show the shape of the dilated duct or the precise location of the intraductal lesion in the breast. We applied three-dimensional (3D) heavily T2-weighted imaging with fat suppression of the breast to produce MR ductography. The dilated ducts are seen in 3D as tubular structures with high signal, and intraductal abnormalities are seen as signal defects. Furthermore, MR ductography can show an obstructed duct that cannot be seen on ductography. We also performed 3D breast MRI with the intravenous infusion of contrast material to show the lesion itself. Finally, we fused these 2 volume images into a single 3D fused image that not only shows the existence of intraductal abnormality, but reveals the shape, size, and extent of lesion, allowing us to understand easily the relationship between the ducts with dilation and any intraductal lesions in the breast. We herein introduce and describe this noninvasive method and discuss various factors related to its diagnostic use.

Implications of nipple discharge in Hong Kong Chinese women

“…16 Its routine use in patients with a breast lesion is nonetheless limited by its relatively low specificity of 72% (95% confidence interval, 67%-77%). 17 The role of magnetic resonance imaging in patients with nipple discharge has been extensively validated, [18][19][20][21] suggesting that it may detect or exclude the presence of carcinoma with a high degree of certainty. Magnetic resonance imaging may be considered when all other available strategies are inconclusive.…”

Ductectasia of the Breast; An Experience With Hadfield Operation (Radical Excision of the Subareolar Duct System)

“…However, further studies are required to define its role more clearly, as there are still limitations in clinical practice (8)(9)(10)(11)(12)(13)(14). Magnetic resonance imaging (MRI) may play an adjunctive role, aiding in the differentiation of benign ductal abnormalities from malignant ones (15)(16)(17)(18). Although not a routine practice in the United Kingdom; a number of techniques have been used to determine the cause of nipple discharge, beyond the triple assessment.…”

Suspicious Nipple Discharge Diagnostic Evaluation

“…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). Advantages to this technique are that it is noninvasive; uses no radiation or contrast material; and causes none of the potential complications associated with cannulation of the duct and injection of contrast medium, including duct perforation, extravasation, and mastitis (Hirose et al, 2007).…”

“…There is evidence in the literatures that CEMRI offers high diagnostic performance for detecting lesions in patients with suspicious ND, even when no lesions are identified by conventional imaging and when DG is not feasible or inconclusive (Sardanelli et al, 2008citing Daniel et al, 2003Hirose et al, 2006;Nakahara et al, 2003;Orel et al, 2000). Lorenzon et al (2011) found that CEMRI could identify 5/5 cancers (sensitivity = 100%) and 13/14 high-risk lesions (sensitivity = 92.9%) (overall sensitivity, 94.7%; overall specificity, 78.9%).…”

“…The single 3D fused image obtained by combining data from indirect MRDG and CEMRI not only demonstrates the existence of an intraductal abnormality but also reveals the shape, size, and extent of the lesion, and can clarify the relationship between the duct and the intraductal lesion (Hirose et al, 2006) (Fig.7).…”