The Adjacent Vessel Sign on Breast MRI: New Data and a Subgroup Analysis for 1,084 Histologically Verified Cases

Abstract

ObjectiveThe adjacent vessel sign (AVS) is a descriptor for differentiating malignant from benign breast lesions on breast MRI (bMRI). This investigation was designed to verify the previous reports on the diagnostic accuracy of AVS and to assess correlation between AVS, histopathological diagnosis, lesion size and lesion grade.Materials and MethodsThis study was approved by the local ethical committee. Experienced radiologists evaluated 1,084 lesions. The exclusion criteria were no histological verification after bMRI and breast interventions that were done up to one year before bMRI (surgery, core biopsy, chemo- or radiation therapy). The native and dynamic contrast-enhanced T1-weighted series were acquired using standardized protocols. The AVS was rated positive if a vessel leading to a lesion could be visualized. Prevalence of an AVS was correlated with the lesions' size, grade and histology using Chi-square-tests.ResultsThe AVS was significantly associated with malignancy (p < 0.001; sensitivity: 47%, specificity: 88%, positive-predictive-value [PPV]: 85%). Malignant lesions > 2 cm more often presented with an AVS than did those malignant lesions < 2 cm (p < 0.0001; sensitivity: 65%, PPV: 90%). There was no correlation of the AVS with the tumor grade. The prevalence of an AVS didn't significantly differ between invasive lobular carcinomas versus ductal carcinomas. In situ cancers were less frequently associated with an AVS (p < 0.001).ConclusionThe adjacent vessel sign was significantly associated with malignancy. Thus, it can be used to accurately assess breast lesions on bMRI. In this study, the AVS was particularly associated with advanced and invasive carcinomas.

Bilateral analysis of the cross-sectional area of the internal mammary arteries and veins in patients with and without breast cancer on breast magnetic resonance imaging

“…Different imaging modalities were used for imaging increased vascularity, for example, laser Doppler perfusion imaging [18], positron emission tomography [19], computed tomography (CT) [20] and MRI [4–6, 8, 10, 21–23]. With respect to MRI, most researchers use one of two methods to assess changes in vascularity in the presence of malignancy.…”

“…The first method focuses on prominent vessels leading to an enhanced lesion, the so-called adjacent vessel sign (AVS) [10]. The second method consists of imaging the vascularity of the whole breast on both sides with contrast-enhanced MRI [8].…”

Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images

“…There was no significant difference in the detection of multifocal disease in minTE and nTE. We were also able to detect tumor vessels in both sequences which is important because the adjacent vessel sign was significantly associated with malignancy [35,36]. To our knowledge, no breast MRI study has dealt with short TE sequences before.…”

Dynamic contrast-enhanced breast magnetic resonance imaging for the prediction of early and late recurrences in breast cancer

“…[15] For adjacent vessel signs on subtracted images, the presence of vessels either entering the enhancing lesion or in contact with the lesion edge was accepted as a positive adjacent vessel sign. [16] Whole-breast vascularity of the ipsilateral breast with cancer was compared with that of the contralateral breast at each maximum-intensity-projection images on the basis of the number of vessels that were 3 cm or longer in length and 2 mm or larger in maximal transverse diameter. [17] The degree of vascularity difference was classified as “prominent” if the number of vessels in the ipsilateral breast was 3 or more than that of the contralateral breast; “moderate” if higher by 2; “mild” if higher by 1; and “not increased” if the number of vessels in the ipsilateral breast was the same as or lower than that of the contralateral breast.…”