The Current Status of Breast MR Imaging Part I. Choice of Technique, Image Interpretation, Diagnostic Accuracy, and Transfer to Clinical Practice

Abstract

Compared with mammography and breast ultrasonography, contrast material-enhanced magnetic resonance (MR) imaging is a breast imaging technique that offers not only information on lesion cross-sectional morphology but also on functional lesion features such as tissue perfusion and enhancement kinetics. After an enthusiastic start to clinical breast MR imaging in the early 1990s, a variety of difficulties and obstacles were identified that hampered the transfer of the modality into clinical practice, including a lack of standardization regarding image acquisition and interpretation guidelines, a lack of MR-compatible interventional materials, and a lack of evidence regarding its diagnostic accuracy--particularly specificity and positive predictive value, as well as sensitivity for ductal carcinoma in situ. This article is the first of two on the current status of breast MR imaging. The pathophysiologic basis of breast MR and the effects on acquisition technique and diagnostic accuracy, the diverging demands of high spatial and temporal resolution, and the different approaches that exist for image acquisition are reviewed. Advantages and disadvantages of different pulse sequence parameters are discussed to help radiologists make a balanced and informed decision regarding choice of image acquisition protocol. Imaging findings in common benign and malignant changes are described, and current concepts for differential diagnosis, including the MR Breast Imaging Reporting and Data System lexicon, are discussed. Furthermore, obstacles that impeded the technique's transfer into clinical practice are discussed, and the progress made in recent years, especially regarding the development of guidelines, procedural standardization, and MR-guided interventions are outlined.

Performance of a fully automatic lesion detection system for breast DCE‐MRI

“…Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a noninvasive imaging technique increasingly used in breast cancer diagnosis as an adjunct to conventional imaging techniques (3,4). DCE-MRI shows promise in detecting both invasive and ductal carcinoma in situ cancers, gives information on the biological aggressiveness of tumors and may be used to evaluate response to neoadjuvant chemotherapy (5)(6)(7)(8).…”

“…Furthermore, to our knowledge these methods have been tested only on non-fat-saturated (fat-sat) contrast-enhanced images. Because enhancing lesions may become isointense to adjacent fatty tissue after contrast material injection, fat-saturation has been introduced to enhance the contrast between lesion and surrounding tissue and to overcome the limitations due to subtraction artifacts (7). However, fat-sat sequences introduce additional challenges for lesion segmentation, such as artifacts from inhomogeneous signal saturation and a lower contrast-to-noise-ratio between enhanced lesions and surrounding parenchyma (17).…”

Near‐infrared imaging of breast cancer using optical contrast agents

“…However, ultrasound and MRI are not suitable for screening, the former because it is examiner-dependent and time-consuming, the latter because it is expensive and has a greatly varying specificity [12][13][14][15].…”

Dynamic Contrast Enhanced Magnetic Resonance Imaging in Rectal Cancer

“…3). Classification of TICs according to this scheme can achieve very good diagnostic performance in differentiating malignant from benign lesions as described in the case of breast lesions (Daniel et al, 1998;Kuhl, 2007;Nishiura et al, 2011). As regards the rectal cancer, many papers explored the possibility to apply a semi-quantitative approach to lesion classification.…”