7 T versus 3 T contrast-enhanced breast Magnetic Resonance Imaging of invasive ductulolobular carcinoma: First clinical experience

Purpose

Here we describe our first experience with contrast-enhanced (CE) MRI of breast cancer at 7 tesla (T), compared to 3 T and histopathology.

Materials and Methods

A 52 year old female patient with a mammographically suspicious breast mass (BI-RADS V) underwent 7 T CE-MRI. Results were described according to the BI-RADS-MRI criteria and compared to 3 T and histopathology.

Results

After contrast administration, a homogeneously enhancing, irregular spiculated mass was depicted at both 3 T and 7 T; sizes were identical. The most malignant kinetic curve was characterized by a rapid initial rise followed by a wash-out pattern in the delayed phase, i.e. a type 3 curve, at both field strengths. Even though T1-effects of contrast agents are suggested to be reduced at higher fields, quantification of contrast enhancement-to-noise ratio showed a ratio of 4.6 at 7 T and 2.8 at 3 T when comparing contrast-to-noise of the mass before and after contrast administration. Both examinations, using a single dose of gadolinium-based contrast agent, achieved good image quality. Final histopathological evaluation showed an invasive ductulolobular carcinoma with an intraductal component.

Conclusion

This initial experience suggests that clinical contrast-enhanced 7 T MRI of the breast is technically feasible and may allow BI-RADS-conform analysis.     

Characterization of pure high-grade DCIS on magnetic resonance imaging using the evolving breast MR lexicon terminology: can it be differentiated from pure invasive disease?

Magnetic resonance imaging (MRI) is now a recognized method of imaging the breast. Unfortunately, there is lack of standardization in the MRI terminology used to characterize the appearance of breast lesions. Moreover, cases of mixed histologies are often imaged. We retrospectively identified cases of pure high-grade ductal carcinoma in situ (DCIS) using the recently introduced breast MRI lexicon and characterized the lesions in order to try and identify features that might distinguish high-grade DCIS from invasive disease. Five-year review of our institution's database revealed 637 patients underwent gadolinium-enhanced breast MRI examination. Twenty patients had histologically proven pure high-grade DCIS. After excluding patients with previous chemotherapy or inadequate MRI examination, 13 patients were analyzed and compared to the 13 most recent cases of pure invasive breast carcinoma. The morphological and dynamic features were then compared. High-grade DCIS cases were significantly more likely to show focal branching pattern (P=.03) and to have an irregular contour (P=.03), compared with invasive disease. Although of marginal statistical significance, DCIS lesions are more likely to have a lower morphological score than invasive carcinoma (P=.06), whilst the latter is more likely to show ring enhancement (P=.07). Use of breast MRI for staging at our institution shows that pure DCIS and pure invasive cancers are both rare entities. Despite the relatively limited numbers, we identified features that would help to differentiate high-grade DCIS from invasive carcinoma on MRI.     

Fractal dimension-bound spatio-temporal analysis of digital mammograms

A new Fractal Dimension-based diagnosis technique for the change detection and time-series analysis of masses in the temporal digital mammogram is presented in this paper. As the digital mammograms are confirmed as a reliable source for the prognosis of breast cancer, the demand for the development of precise computer aided detection techniques is constantly on the increase. This formed the basis for the development of this method using Fractal geometry, which is an efficient mathematical approach that deals with self-similar and irregular geometric objects called fractals. This work comprises of the detection of spatial masses using Fractal Hurst bound enhancement and segmentation of those temporal masses using Fractal Thresholding. The consultant radiologist’s assessment of mass lesions forms the baseline for comparison and validation of the detected masses. Further, this research work performs temporal analysis of mass lesions, detected from the mammograms of the current and the respective prior view using the principle of Fractal Dimension. The precision of Fractal-dimension based temporal texture analysis of malignant masses of digital mammograms subsequently attributes to their characterization.     

Research and progress in magnetic resonance imaging of triple-negative breast cancer

Triple-negative breast cancer (TNBC), which characterized by distinct biological and clinical pathological features, has a worse prognosis because the lack of effective therapeutic targets. Breast MR is the most accurate imaging modality for diagnosis of breast cancer currently. MR imaging recognition could assist in diagnosis, pretreatment planning and prognosis evaluation of TNBC. MR findings of a larger solitary lesion, mass with smooth mass margin, high signal intensity on T₂-weighted images and rim enhancement are typical MRI features associated with TNBC. Further work is necessary about the clinical application of dynamic contrast-enhanced MR imaging (DCE-MRI), DWI and MRS.     

Classification of breast mass lesions using model-based analysis of the characteristic kinetic curve derived from fuzzy c-means clustering

The purpose of this study is to evaluate the diagnostic efficacy of the representative characteristic kinetic curve of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) extracted by fuzzy c-means (FCM) clustering for the discrimination of benign and malignant breast tumors using a novel computer-aided diagnosis (CAD) system. About the research data set, DCE-MRIs of 132 solid breast masses with definite histopathologic diagnosis (63 benign and 69 malignant) were used in this study. At first, the tumor region was automatically segmented using the region growing method based on the integrated color map formed by the combination of kinetic and area under curve color map. Then, the FCM clustering was used to identify the time-signal curve with the larger initial enhancement inside the segmented region as the representative kinetic curve, and then the parameters of the Tofts pharmacokinetic model for the representative kinetic curve were compared with conventional curve analysis (maximal enhancement, time to peak, uptake rate and washout rate) for each mass. The results were analyzed with a receiver operating characteristic curve and Student's t test to evaluate the classification performance. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the combined model-based parameters of the extracted kinetic curve from FCM clustering were 86.36% (114/132), 85.51% (59/69), 87.30% (55/63), 88.06% (59/67) and 84.62% (55/65), better than those from a conventional curve analysis. The A(Z) value was 0.9154 for Tofts model-based parametric features, better than that for conventional curve analysis (0.8673), for discriminating malignant and benign lesions. In conclusion, model-based analysis of the characteristic kinetic curve of breast mass derived from FCM clustering provides effective lesion classification. This approach has potential in the development of a CAD system for DCE breast MRI.     

Relationship between lesion size and signal enhancement on subtraction fat-suppressed MR imaging of the breast

OBJECTIVE: To investigate the relationship between size and whole lesion enhancement of breast neoplasms. MATERIALS AND METHODS: Fat-suppressed subtraction MRI was performed in 94 breast lesions (44 malignant, 50 benign) with pathologically confirmed diagnoses. Of these, all malignant lesions and 31 of the 50 benign lesions showed enhancement. The degree of enhancement was quantified by using an ROI tracing around the whole lesion and calculated as the percentage increase in signal intensity between the corresponding precontrast and postcontrast images. RESULTS: The 44 malignant lesions showed enhancement percentage of 38.3% to 186.4% (mean 109.9%), and the 31 benign lesions showed enhancement percentage of 12.8% to 180.2% (mean 79.5%). The difference is statistically significant (P = .002). In 54 small lesions (28 malignant, 26 benign) with enhancing pixel areas of <300 mm(2) corresponding to a diameter of approximately 19.5 mm, an enhancement exceeding 75% of baseline separated malignant lesions (mean enhancement 116.7%) from benign ones (mean enhancement 72.8%) (P = .0001). This gave a sensitivity of 100% and a specificity of 69%, a positive predictive value of 78%, negative predictive value of 100% and an accuracy of 85% in using >75% enhancement increase in detecting malignancy in small (<300 mm(2)) enhancing lesions. CONCLUSION: The high sensitivity in the detection of small malignant lesions suggests a potential for the method to be used in assessment of small enhancing breast lesions.     

Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity

PURPOSE: The aim of this study was to evaluate the frequency and magnetic resonance imaging (MRI) features of clinically benign, small (<2 cm) hyperintense hepatic lesions in the cirrhotic liver on T1-weighted MR images seen at serial MRI. MATERIALS AND METHODS: This study included 189 patients with cirrhosis, who underwent hepatic MRI more than twice with an interval of at least 12 months. The initial MR images were reviewed for the presence of small hyperintense lesions on T1-weighted images. The size, location and signal intensity on T2-weighted images as well as enhancement patterns of the corresponding lesions were recorded. RESULTS: On the initial T1-weighted MR images, 43 small hyperintense hepatic lesions were detected in 23 (12%) of 189 patients. Twelve (28%) of 43 lesions showed early enhancement and were pathologically diagnosed as hepatocellular carcinoma (HCC) during the follow-up period. Thirty-one (72%) of 43 lesions showed no early enhancement with various signal intensity on T2-weighted images (hyperintensity=4, isointensity=20, hypointensity=7). Among these 31 lesions, 12 showed no interval change, while 11 disappeared (n=10) or decreased in size (n=1). In the remaining eight lesions, seven were diagnosed as HCC on the basis of pathologic confirmation or the interval growth. CONCLUSION: Small hyperintense hepatic lesions on T1-weighted magnetic resonance (MR) images without early enhancement on the arterial-phase contrast-enhanced dynamic studies in patients with cirrhosis usually showed no interval growth or disappeared during the serial MRI. These lesions with additional findings of iso- or hypointensity on the T2-weighted MR images without "washout effect" on the contrast-enhanced equilibrium-phase images may more frequently be clinically benign or hyperplastic nodules than HCCs.     

Water-selective spectral-spatial contrast-enhanced breast MRI for cancer detection in patients with extracapsular and injected free silicone

OBJECTIVE: This study investigates the use of contrast-enhanced, T1-weighted, water-selective spectral-spatial 3D gradient echo magnetic resonance imaging (MRI) with magnetization transfer (3DSSMT) for detecting breast cancer in patients with intraparenchymal silicone. CONCLUSION: Water-selective 3DSSMT provides superior fat and silicone suppression in patients with free silicone as compared with conventional fat saturation. It enables direct, high-quality, high-spatial-resolution, T1-weighted breast MRI of contrast enhancement without the need for subtraction processing and aids diagnosis of cancer in the breast with free silicone.     

Dynamic sequential 3D gadolinium-enhanced MRI of the whole breast

Dynamic contrast-enhanced 2D MR imaging of the breast has shown high sensitivity and specificity for the detection and characterization of breast lesions. We investigated the ability of a dynamic fast 3D MR imaging technique that repeatedly scans the whole breast in 44-s intervals without an interscan delay time to obtain similar sensitivity and specificity as 2D imaging. Fifty-six patients scheduled for breast biopsy were entered into the study, and 83 lesions detected by 3D dynamic scanning were biopsied. Dynamic 3D contrast-enhanced breast imaging with subtraction detected and correctly classified all 23 cancers, and 44 of the 60 benign lesions yielding a sensitivity of 100%, a specificity of 73%, and a 100% predictive negative value. The enhancement profiles of metastatic lymph nodes were similar to those of primary cancer. This technique allowed detection of multifocal and multicentric lesions and did not require a priori knowledge of lesion location. These results indicate that dynamic contrast-enhanced 3D MRI of the whole breast is a useful and economically feasible method for staging breast cancer, providing a comprehensive noninvasive method for total evaluation of the breast and axilla in patients considering breast conservation surgery or lumpectomy.     

MR imaging of the ischiopubic synchondrosis

The ischiopubic synchondrosis (IPS) is a temporary joint, occurring in childhood prior to fusion of the ischial and pubic bones. On conventional radiographs this tumor-like appearance is a well known normal anatomic variant, however, there are no reports in the literature of the appearance of IPS on MRI. Therefore the purpose of this study was to evaluate typical magnetic resonance features of the IPS. All pelvic MRIs from 1/1992 to 4/1998 of children ranging in age from 4 to 16 years, who were scanned for reasons other than bone disorders, were retrospectively investigated. Twenty-eight children were included and the morphologic appearance of IPS on MRI was evaluated. Seventeen (61%) of these 28 children had the following findings of IPS on MRI. Listed in order of frequency we found signal alteration of the ischiopubic fusion zone [hyperintense on T(2) with fat-saturation (89%) or STIR (74%), hypointense on T(1) (71%)], fibrous "bridging" (68%) [hypointense band on all sequences in perpendicular orientation to the axis of the inferior pubic ramus], fusiform swelling (68%), signal alteration of the adjacent soft tissue (57%) and irregular margins (56%). In 10 children contrast enhanced scans were available for evaluation, showing contrast enhancement of the bone marrow in 83.3% and of the adjacent soft tissue in 66.7%. Fusiform swelling of the ischiopubic fusion zone, signal alteration and contrast enhancement of both the bone marrow and the adjacent soft-tissue are characteristic features of the IPS on MRI, which may be due to mechanical stress at this temporary joint. These features are nonspecific and may resemble tumor, infection or trauma. Fibrous "bridging" was the only finding on MRI, which has not been described for any other entity and thus, it seems to be a characteristic MRI-feature.     

Paradoxical uptake of Gd-EOB-DTPA on the hepatobiliary phase in the evaluation of hepatic metastasis from breast cancer: is the “target sign” a common finding?

Purpose

The purpose was to describe magnetic resonance imaging (MRI) findings of breast cancer liver metastasis using gadoxetic acid (Gd-EOB-DTPA) with an emphasis on the added value of the hepatobiliary phase (HBP).

Material and methods

Nine patients with 13 liver metastases were included in the study after the medical records of 29 breast cancer patients who underwent Gd-EOB-DTPA-enhanced MRI between February 2008 and June 2010 were reviewed. The diagnoses of liver metastasis were established by percutaneous liver biopsy or surgery and on the basis of image findings. Two radiologists retrospectively evaluated signal intensity (SI) and sizes of metastases and patterns of enhancement in an HBP. The SI ratio was calculated as the SI of the central hyperintense portion in “target” lesions divided by the SI of nearby normal liver parenchyma on the HBP. We also measured apparent diffusion coefficient (ADC) values from Diffusion Weighted Image (DWI).

Results

Liver metastases were all hypointense [n=13/13 (100%)] on T1-weighted imaging (WI), and many lesions had a “target” appearance with a central high SI and a peripheral low SI rim (47%) on T2WI. Dynamic study showed rim enhancement on the arterial phase (85%) and a “target” appearance, consisting of a central enhancing portion with peripheral washout or hypointense rim, on the HBP (62%). The mean SI ratio was 0.7. The mean ADC value of “target” appearing metastases was 1.25 (×10⁻³ mm²/s; range 1.3–1.6) compared with a mean value of 0.8 (×10⁻³ mm²/s; range 0.8–1.4) in homogeneous defect on the HBP. There was statistically significant difference (P<.05).

Conclusion

Breast cancer liver metastases commonly demonstrated as a peripheral ring enhancement on arterial dominant phase and a target sign with a central round enhancing portion and a peripheral hypointense rim on the HBP.     

MRI of uterine leiomyosarcoma

We report a case of a patient with uterine leiomyosarcoma. At MR imaging, the patient was found to have a bilobed uterine mass with two components. While the caudal portion of the mass had the MRI appearance of a simple leiomyoma, the cephalad component showed atypical degeneration with an irregular contour. Malignant degeneration of a leiomyoma was confirmed by operative and histologic examination. We conclude that malignant degeneration should be considered on MR images of any degenerated leiomyoma showing an irregular contour.     

Early assessment of breast cancer response to neoadjuvant chemotherapy by semi-quantitative analysis of high-temporal resolution DCE-MRI: Preliminary results

Purpose

To evaluate whether semi-quantitative analysis of high temporal resolution dynamic contrast-enhanced MRI (DCE-MRI) acquired early in treatment can predict the response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NAC).

Materials and Methods

As part of an IRB-approved prospective study, 21 patients with LABC provided informed consent and underwent high temporal resolution 3 T DCE-MRI before and after 1 cycle of NAC. Using measurements performed by two radiologists, the following parameters were extracted for lesions at both examinations: lesion size (short and long axes, in both early and late phases of enhancement), radiologist's subjective assessment of lesion enhancement, and percentages of voxels within the lesion demonstrating progressive, plateau, or washout kinetics. The latter data were calculated using two filters, one selecting for voxels enhancing ≥ 50% over baseline and one for voxels enhancing ≥ 100% over baseline. Pretreatment imaging parameters and parameter changes following cycle 1 of NAC were evaluated for their ability to discriminate patients with an eventual pathological complete response (pCR).

Results

All 21 patients completed NAC followed by surgery, with 9 patients achieving a pCR. No pretreatment imaging parameters were predictive of pCR. However, change after cycle 1 of NAC in percentage of voxels demonstrating washout kinetics with a 100% enhancement filter discriminated patients with an eventual pCR with an area under the receiver operating characteristic curve (AUC) of 0.77. Changes in other parameters, including lesion size, did not predict pCR.

Conclusion

Semi-quantitative analysis of high temporal resolution DCE-MRI in patients with LABC can discriminate patients with an eventual pCR after one cycle of NAC.     

Imaging features of small (≤ 3 cm) pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience

Objective

The objective was to determine imaging features that distinguish small (≤3cm) solid pancreatic adenocarcinoma, neuroendocrine tumor (NET) and solid pseudopapillary tumor (SPT) on gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighed imaging (DWI).

Materials and methods

Twenty-four adenocarcinomas, 10 NETs and 8 SPTs were retrospectively included. Two radiologists analyzed morphologic features, signal intensity of the tumors on MR images including DWI (b=800) and dynamic enhancement pattern with consensus. Tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.

Results

All adenocarcinomas had an ill-defined margin and irregular shape, and more frequently had pancreatic duct dilatation compared with other tumors (P<.05). All SPTs and all but one of the adenocarcinomas (95.8%) had no arterial enhancement with progressively increased enhancement, whereas seven NETs (70%) had arterial enhancement with progressively decreased enhancement (P<.01). The mean value of tumor-to-parenchyma ratio on arterial and portal phases was significantly higher for NETs, and the mean value of tumor ADCs was significantly lower for SPTs than for other tumors (P<.05).

Conclusions

Gadoxetic-acid-enhanced MRI may aid in differentiation between small adenocarcinomas, NETs and SPTs based on morphologic features with dynamic enhancement pattern in adenocarcinomas, dynamic enhancement pattern with tumor-to-parenchyma ration on arterial and portal phases in NETs, and dynamic enhancement pattern with lower ADC value in SPTs.     

Giant hemangioma of the liver: MR imaging characteristics in 24 patients

We retrospectively reviewed the magnetic resonance imaging (MRI) of giant hemangiomas in 24 patients. MRI studies comprised T1-weighted, T2-weighted and serial gadolinium-enhanced spoiled gradient echo (SGE) images. Morphologic features, signal characteristics and enhancement patterns were assessed. Histopathologic evaluation was obtained in nine patients. On T2-weighted images all lesions (size 5.7-24 cm) were hyperintense relative to the spleen and two dominant patterns of heterogeneity were demonstrated: a central heterogeneous area of either bright, dark, or mixed signal intensity, and a network of multiple fibrous septa of low signal intensity. Histopathologic evaluation of two lesions with a central bright area demonstrated the presence of hypocellular myxoid tissue. Central enhancement (9 lesions) and an irregular flame-shaped peripheral pattern of enhancement (12 lesions) were present in lesions with a mean diameter greater than 10 cm. Although giant hemangiomas show greater variability in their MR imaging appearance, an accurate diagnosis can be made through still characteristic features of high signal intensity on T2-weighted images and discontinuous peripheral enhancement.     

Triple-negative breast cancer: Pretreatment magnetic resonance imaging features and clinicopathological factors associated with recurrence

PurposeWe aimed to investigate the magnetic resonance imaging (MRI) features and clinicopathologic factors with recurrence of triple-negative breast cancer (TNBC).Patients and methodsWe identified 281 patients with 288 surgically confirmed TNBC lesions who underwent pretreatment MRI between 2009 and 2015. The presence of intratumoral high signal on T2-weighted images, high-signal rim on diffusion-weighted images (DWI), and rim enhancement on the dynamic contrast-enhanced MRI and clinicopathological data were collected. Cox proportional analysis was performed.ResultsOf the 288 lesions, 36 (12.5%) recurred after a median follow-up of 18 months (range, 3.6–68.3 months). Rim enhancement (hazard ratio [HR] = 3.15; 95% confidence interval [CI] = 1.01, 9.88; p = .048), and lymphovascular invasion (HR = 2.73, 95% CI = 1.20, 6.23; p = .016) were independently associated with disease recurrence. While fibroglandular volume, background parenchymal enhancement, intratumoral T2 high signal, and high-signal rim on DWI, were not found to be risk factors for recurrence.ConclusionPretreatment MRI features may help predict a high risk of recurrence in patients with TNBC.     

MRI of tarantulas: morphological and perfusion imaging

This paper describes a study performed to evaluate the feasibility of using a 1.5-T whole-body magnetic resonance imaging (MRI) equipment, in combination with pharmacokinetic modeling, to obtain in vivo information about the morphology and perfusion of tarantulas (Eurypelma californicum). MRI was performed on three tarantulas using spin-echo sequences for morphological imaging and a rapid spoiled gradient-echo sequence for dynamic imaging during and after contrast medium (CM; Gd-DTPA) injection. Signal enhancement in dynamic measurements was evaluated with a pharmacokinetic two-compartment model. Spin-echo images showed morphological structures well. Dynamic images were of sufficient quality and allowed a model analysis of CM kinetics, which provides information about regional perfusion. In conclusion, morphological and dynamic contrast-enhanced MRI of tarantulas is feasible with a conventional clinical scanner. Studies of this kind are therefore possible without a dedicated high-field animal scanner.     

Preliminary report on detection of papillomaviruses types 6, 11, 16, and 18 in laryngeal benign and malignant lesions

Recently, clinicians have observed an increase in the incidence of laryngeal papilloma coincident with the rising incidence of venereal warts. The lesions occur in young adults of professional singing age. Different types of human papillomavirus (HPV) are presented. Gynecologic exam revealed cervical tumors, involving 18 HPV in benign and malignant lesions. Thirty patients with the following pathologic conditions were studied: 10 papillomas, 10 severe dysplasias, and 10 invasive cancers. All the lesions were located on the free edge of the vocal folds or the anterior commissure involving the epithelium. The results are as follows: 11 patients (33%) had virus infection, of which four had HPV 6 or HPV 11 on laryngeal papilloma, three had HPV 16 or HPV 18 on severe dysplasia, four had HPV 16 or HPV 18 on carcinoma; and 19 (66%) had no virus infection. Gynecologic research in this field is more advanced. However, this preliminary report raises interesting research questions in laryngology.