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We sought factors associated with false-negative and false-positive results in the diagnosis of breast lesions using the Kaiser score (KS) on breast magnetic resonance imaging (MRI). We retrospectively analyzed 1058 patients with 1058 breast lesions who underwent preoperative breast MRI with successful histopathologic results. Two radiologists assessed each lesion according to KS criteria, and clinicopathologic features and MRI findings were analyzed. Multivariate regression analysis was conducted to identify factors associated with false-negative and false-positive KS results. Of the 1058 lesions, 859 were malignant and 199 were benign. Particularly high misdiagnosis rates were observed for intraductal papilloma, inflammatory lesion, and mucinous carcinoma. For breast cancer, KS yielded 821 (95.6 %) true-positive and 38 (4.4 %) false-negative results. Multivariate analysis showed that smaller lesion size (≤1 cm) (OR, 3.698; 95 %CI, 1.430–9.567; p = 0.007), absence of ipsilateral breast hypervascularity (OR, 3.029; 95 %CI, 1.370–6.693; p = 0.006), and presence of hyperintensity on T2WI (OR, 2.405; 95 %CI, 1.121–5.162; p = 0.024) were significantly associated with false-negative breast cancer results. For benign lesions, KS yielded 141 (70.9 %) true-negative and 58 (29.1 %) false-positive results. Multivariate regression analysis revealed that non-mass enhancement lesions (OR, 4.660; 95 %CI, 2.018–10.762; p＜0.001), moderate/high background parenchymal enhancement (OR, 2.402; 95 %CI, 1.180–4.892; p = 0.016), and the presence of hyperintensity on T2WI (OR, 2.986; 95 %CI, 1.386–6.433; p = 0.005) were significantly associated with false-positive KS results. Several clinicopathologic and MRI features influence the accuracy of KS diagnosis. Understanding these factors may facilitate appropriate use of KS and guide alternative diagnostic approaches, ultimately improving diagnostic accuracy in the evaluation of breast lesions. [ABSTRACT FROM AUTHOR]

To investigate the independent risk variables associated with the potential invasiveness of ductal carcinoma in situ (DCIS) on multi-parametric ultrasonography, and further construct a nomogram for risk assessment. Consecutive patients from January 2017 to December 2022 who were suspected of having ductal carcinoma in situ (DCIS) based on magnetic resonance imaging or mammography were prospectively enrolled. Histopathological findings after surgical resection served as the gold standard. Grayscale ultrasound, Doppler ultrasound, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) examinations were preoperative performed. Binary logistic regression was used for multifactorial analysis to identify independent risk factors from multi-parametric ultrasonography. The correlation between independent risk factors and pathological prognostic markers was analyzed. The predictive efficacy of DCIS associated with invasiveness was assessed by logistic analysis, and a nomogram was established. A total of 250 DCIS lesions were enrolled from 249 patients, comprising 85 pure DCIS and 165 DCIS with invasion (DCIS-IDC), of which 41 exhibited micro-invasion. The multivariate analysis identified independent risk factors for DCIS with invasion on multi-parametric ultrasonography, including image size (>2cm), Doppler ultrasound RI (≥0.72), SWE's Emax (≥66.4 kPa), hyper-enhancement, centripetal enhancement, increased surrounding vessel, and no contrast agent retention on CEUS. These factors correlated with histological grade, Ki-67, and human epidermal growth factor receptor 2 (HER2) (P < 0.1). The multi-parametric ultrasound approach demonstrated good predictive performance (sensitivity 89.7 %, specificity 73.8 %, AUC 0.903), surpassing single US modality or combinations with SWE or CEUS modalities. Utilizing these factors, a predictive nomogram achieved a respectable performance (AUC of 0.889) for predicting DCIS with invasion. Additionally, a separate nomogram for predicting DCIS with micro-invasion, incorporating independent risk factors such as RI (≥0.72), SWE's Emax (≥65.2 kPa), and centripetal enhancement, demonstrated an AUC of 0.867. Multi-parametric ultrasonography demonstrates good discriminatory ability in predicting both DCIS with invasion and micro-invasion through the analysis of lesion morphology, stiffness, neovascular architecture, and perfusion. The use of a nomogram based on ultrasonographic images offers an intuitive and effective method for assessing the risk of invasion in DCIS. Although the nomogram is not currently considered a clinically applicable diagnostic tool due to its AUC being below the threshold of 0.9, further research and development are anticipated to yield positive outcomes and enhance its viability for clinical utilization. [ABSTRACT FROM AUTHOR]

• Low-field technology promises to substantially decrease the procedural costs of breast MRI. • Low-field technology supports operating MRI units directly at the breast clinic. • Low-field scanners may facilitate integrating MRI into the diagnostic at the breast clinic. • Low-field breast MRI was feasible at diagnostic image quality at acceptable examination time. Broader clinical adoption of breast magnetic resonance imaging (MRI) faces challenges such as limited availability and high procedural costs. Low-field technology has shown promise in addressing these challenges. We report our initial experience using a next-generation scanner for low-field breast MRI at 0.55T. This initial cases series was part of an institutional review board-approved prospective study using a 0.55T scanner (MAGNETOM Free.Max, Siemens Healthcare, Erlangen/Germany: height < 2 m, weight < 3.2 tons, no quench pipe) equipped with a seven-channel breast coil (Noras, Höchberg/Germany). A multiparametric breast MRI protocol consisting of dynamic T1-weighted, T2-weighted, and diffusion-weighted sequences was optimized for 0.55T. Two radiologists with 12 and 20 years of experience in breast MRI evaluated the examinations. Twelve participants (mean age: 55.3 years, range: 36–78 years) were examined. The image quality was diagnostic in all examinations and not impaired by relevant artifacts. Typical imaging phenotypes were visualized. The scan time for a complete, non-abbreviated breast MRI protocol ranged from 10:30 to 18:40 min. This initial case series suggests that low-field breast MRI is feasible at diagnostic image quality within an acceptable examination time. [ABSTRACT FROM AUTHOR]

To evaluate the role of Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT as a metabolic guide in increasing the accuracy, diagnostic yield and safety of CT-guided percutaneous needle lung biopsy (PNB). Retrospective analysis of 340 consecutive patients with suspicious lung nodules, masses or extensive disease that underwent lung biopsy over a 3-year period. Patients were divided into three groups; those that had PET/CT prior to the biopsy, those that had PET-CT following the biopsy and those who did not undergo PET-CT. Correlation was made with the histopathological result. 353 PNBs were performed (median lesion size 30 mm, 7–120 mm) with overall diagnostic rate of 83.9 % (95.8 % malignant). Biopsy success rate was 88.8 % with PET-CT pre-PNB, versus 78.9 % of 175 PNB without PET-CT upfront (p < 0.01 Fisher exact test). Correct targeting to PET-CT-maximum activity area (MAA) was present in 87.1 %. Biopsy success rate was 88.8 % for PNBs targeting the PET-CT-MAA region and only 52.8 % for PNBs not targeting the PET-CT-MAA (p < 0.0001). PET-CT pre-PNB had higher rates of PET-CT-MAA targeting compared to PET-CT post PNB (91.0 % v 80.0 %, p = 0.01). The availability of PET-CT before the PNB lead to significantly increased biopsy success rates in patients with a mass (OR:7.01p = 0.004), compared to a nodule (p = 0.498) or multiple nodules (p = 0.163). Patients with a PET-CT pre-PNB underwent fewer PNB passes (mean 2.6 v 3.1, p < 0.0001 Mann Whitney U). Serious complications were less common in PET-CT pre-PNB group (4.5 % v 10.9 %, p < 0.05). Pre-PNB PET-CT performance improvement applied to all 3 radiologists and was greatest for masses and infiltrative abnormalities. Metabolic information provided by 18F-FDG PET/CT and PNB localisation to the PET-CT maximum activity region is associated with higher diagnostic biopsy rates especially in masses and appears to account for improved performance, less needle passes and complications when available pre-biopsy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the radiologic and clinicopathologic factors in radiologic-pathologic discordance (false-negative results) in breast cancer patients who demonstrate radiologic complete response (rCR) in MR imaging after neoadjuvant chemotherapy (NAC).Method: Our institutional review board approved this retrospective study. We included 209 consecutive patients who showed rCR in MR imaging after NAC. rCR was diagnosed when the original lesion site showed no enhancement. Pathologic CR (pCR) was defined as the complete absence of both invasive cancer and ductal carcinoma in situ in the breast upon pathology. Clinicopathologic and radiologic factors affecting the radiologic-pathologic correlation were analyzed.Results: pCR was noted in 108 patients (51.7%); the remaining 101 (48.3%) had residual lesion on pathology. False negative rCR findings were significantly more frequent in cases of 1 or 2 histologic grade (p = 0.001), low tumor-infiltrating lymphocytes (p = 0.004), and luminal A or B subtype (p < 0.001). Multivariate analysis of radiologic findings to identify predictors of false negative findings found calcifications in mammography (p = 0.037), multifocal multicentric lesions (p = 0.004), and non-mass enhancement in pretreatment MR imaging (p = 0.023) to be significantly associated with false-negative findings.Conclusions: Patients with calcification in mammography, multifocal multicentric lesions, and non-mass enhancement in pretreatment MR imaging are significantly associated with false-negative results who showed rCR on MR imaging after NAC. These patient populations should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Purpose: To compare the diagnostic performance of the kinetic parameter maximum slope (MS) in breast lesions obtained by ultrafast dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) of the contrast wash-in period with that of the washout index (WI) derived from standard DCE MRI and that of the Breast Imaging Reporting and Data System (BI-RADS) category.Materials and Methods: In total, 138 contrast enhanced lesions (90 malignant, 48 benign) were evaluated. Ultrafast DCE MRI images were acquired using a k-space-weighted image contrast (KWIC), obtained 0-1 min after gadolinium injection (3.75 s/frame; 16 frames) and followed by standard DCE MRI (60 s/frame, 3 frames). MS was calculated for the KWIC time series as percentage relative enhancement per second (%/s). As a semi-quantitative parameter for the standard DCE MRI time series, WI was evaluated using the change in signal intensity between early and delayed phases. The diagnostic performance (malignant/benign differentiation) of MS, WI, and BI-RADS category was compared by ROC analysis using the area under the curve (AUC).Results: The AUC of MS was as good as that of WI (0.81 vs. 0.79, respectively; P = 0.81), yet inferior to the BI-RADS category (0.81 vs. 0.96, respectively; <0.001). MS tended to have higher sensitivity (91.1% [82/90]) compared with WI (87.8% [79/90]) with same specificity (62.5% [30/48]).Conclusions: MS obtained by ultrafast DCE MRI of the breast is a promising kinetic parameter in the differential diagnosis of malignant and benign breast lesions with decreased scanning time. [ABSTRACT FROM AUTHOR]

Purpose: To determine preoperative magnetic resonance imaging (MRI) features associated with positive or close margins in patients with breast cancer who underwent breast-conserving surgery (BCS).Materials and Methods: A retrospective review identified 249 patients with invasive ductal carcinoma (IDC) who underwent preoperative MRI and BCS as a primary procedure between 2008 and 2010. The MR images were reviewed for descriptions of findings with no new interpretations made. Margins were defined as positive (tumor touching the inked specimen margin), close (<2 mm tumor-free margin), or negative (≥2 mm tumor-free margin). Multivariate logistic regression analysis was performed to evaluate imaging and clinical factors predictive of positive or close margins.Results: Of the 249 patients, 83 (33.3%) had positive or close margins and 166 (66.7%) had negative margins on the initial BCS specimen. Multivariate analysis showed that multifocal disease (odds ratio, 4.8; 95% CI, 1.9-12.2; p =  0.001), nonmass enhancement lesion (odds ratio, 3.0; 95% CI, 1.5-6.2, p =  0.003), greater background parenchymal enhancement (odds ratio, 2.5; 95% CI, 1.1-5.6; p =  0.023), larger lesion size (odds ratio, 1.3; 95% CI, 1.0-1.7, p =  0.032), and presence of ductal carcinoma in situ on needle biopsy (odds ratio, 2.4; 95% CI, 1.3-4.6; p = 0.008) were independent predictors of positive or close margins.Conclusions: Multifocal disease, nonmass enhancement lesion, or greater background parenchymal enhancement on preoperative breast MRI were significantly associated with positive or close margins. Identifying these MRI features before surgery can be helpful to reduce the reoperation rate in BCS. [ABSTRACT FROM AUTHOR]

Purpose: The Pre-Operative MRI of the Breast (POMB) trial was a randomized, prospective, multicenter trial evaluating the impact of pre-operative breast MRI on treatment regimens and short-term surgical outcomes in women up to 56 years of age with breast cancer. The purpose of this study was to evaluate the performance of pre-operative breast MRI in the POMB trial with respect to incremental MRI findings - over conventional breast imaging methods - and their concordance with histopathology.Patients and Methods: Two-hundred and ten patients (n = 210) participating in the POMB trial underwent pre-operative breast MRI at two Swedish breast units. Positive predictive values (PPV) for the incremental MRI findings were calculated for three subgroups of patients with: 1. alteration/alterations of treatment plan; 2. no alteration of treatment plan; and, 3. MRI-related conversion from BCS to mastectomy. Area under the receiver operating characteristic curve (AUC) was calculated using in-breast BI-RADS based ratings for the whole MRI group.Results: After exclusions a total number of 99 incremental findings in 78 patients were eligible for statistical analysis resulting in a PPV = 74%: (95% CI 60-84%) in 39 patients with MRI related alterations of initial treatment plans and 27%: (95% CI 14-44%) in 39 patients without. Positive predictive values of incremental findings decisive for specific treatment alteration/s were 83% (95% CI 68-92%) in patients with any alteration of initial treatment plans and 91% (95% CI 70-98%) for patients (n = 20/22) with conversion from breast conserving surgery to mastectomy. The empirical AUC for the incremental findings in the whole MRI group was 85% (95% CI 78-91%).Conclusion: Breast MRI, performed and evaluated together with conventional breast imaging methods can provide relevant information at a high degree of accuracy in the pre-operative setting. [ABSTRACT FROM AUTHOR]

Objective: Different molecular subtypes of triple-negative breast cancer (TNBC) have previously been identified through analysis of gene expression profiles. The luminal androgen receptor (LAR) subtype has been shown to have a lower rate of pathologic complete response to neoadjuvant chemotherapy than other TNBC subtypes. The purpose of this study was to determine if the imaging features of TNBCs differ by AR (androgen receptor) status, which is a surrogate immunohistochemical (IHC) marker for the chemoresistant LAR subtype of TNBC.Materials and Methods: This sub-study was part of a clinical trial in patients with stage I-III TNBC who were prospectively monitored for response while receiving neoadjuvant systemic therapy (NAST) at a single comprehensive cancer center. This interim imaging analysis included 144 patients with known AR status measured by IHC. AR-positive (AR+) tumors were defined as those in which at least 10% of tumor cells had positive nuclear AR staining. Two experienced, fellowship-trained breast radiologists who were blinded to the IHC results retrospectively reviewed and reached consensus on all imaging studies for the index lesion (i.e., mammogram, ultrasound, and breast magnetic resonance imaging). The index lesion for each patient was reviewed and described according to the fifth edition of the Breast Imaging Reporting and Data System lexicon. Logistic regression modeling was used to identify imaging features predictive of AR status. p ≤ 0.05 was considered statistically significant.Results: Univariate logistic regression models for AR status showed that AR+ TNBC was significantly associated with heterogeneously dense breast composition on mammography (p = 0.02), mass with calcifications (p = 0.05), irregular mass shape on mammography (p = 0.03), and irregular mass shape on sonography (p = 0.003). Multivariate logistic regression models for AR status showed that AR+ TNBC was significantly associated with heterogeneously dense breast composition on mammography (p = 0.01), high mass density on mammography (p = 0.003), and irregular mass shape on sonography (p = 0.0004).Conclusion: The imaging features of TNBCs differ by AR status. Multimodality breast imaging may help identify the LAR subtype of TNBC, which has been shown to be a subtype that is relatively resistant to neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

• VAE under ultrasound guidance of small breast cancers. • None of the tumours were completely removed in first VAE specimen. • In 50 % the surgical specimen was free of invasive cancer. The purpose of this study was to evaluate if it is possible to completely remove small breast cancer tumours with vacuum-assisted excision (VAE) under ultrasound guidance. Women ≥ 50 years old with a biopsy proven invasive cancer ≤ 10 mm were selected between October 2021 and November 2021 based on referrals and enrolled in this prospective study. The patients underwent VAE within six weeks following biopsy to remove the tumour. After the tumour was excised and the biopsy cavities margins were shaved, a radioactive seed was inserted into the biopsy cavity. The VAE excision cavity and surrounding tissue were surgically excised. Preliminary VAE results were evaluated after ten patients. For the study to proceed at least 80 % of the breast cancer tumours had to be completely removed by VAE. The tumours median size in mammography was 8.5 mm (6–9 mm) and in ultrasound 6.5 mm (4–9 mm). The shape of the lesion was round in three (30 %), oval in two (20 %) and irregular in five (50 %) patients. None of the tumours were completely removed in the first VAE specimen, meaning that there was invasive cancer or ductal carcinoma in situ (DCIS) in the "shaved margins" and/or the surgical specimen. In five (50 %) cases, the surgical specimen was free of invasive cancer and DCIS. None of the small invasive breast cancers were completely excised with VAE under ultrasound guidance, therefore it is not a reliable method to remove small breast cancers. [ABSTRACT FROM AUTHOR]

This study aimed to assess the technical feasibility, the impact on image quality, and the acquisition time (TA) of a new deep-learning-based reconstruction algorithm in diffusion weighted imaging (DWI) of breast magnetic resonance imaging (MRI). Retrospective analysis of 55 female patients who underwent breast DWI at 1.5 T. Raw data were reconstructed using a deep-learning (DL) reconstruction algorithm on a subset of the acquired averages, therefore a reduction of TA. Clinically used standard DWI sequence (DWI Std) and the DL-reconstructed images (DWI DL) were compared. Two radiologists rated the image quality of b800 and ADC images, using a Likert-scale from 1 to 5 with 5 being considered perfect image quality. Signal intensities were measured by placing a region of interest (ROI) at the same position in both sequences. TA was reduced by 40 % in DWI DL , compared to DWI Std , DWI DL improved noise and sharpness while maintaining contrast, the level of artifacts, and diagnostic confidence. There were no differences regarding the signal intensity values of the apparent diffusion coefficient (ADC), (p = 0.955), b50-values (p = 0.070) and b800-values (p = 0.415) comparing standard and DL-imaging. Lesion assessment showed no differences regarding the number of lesions in ADC and DWI (both p = 1.000) and regarding the lesion diameter in DWI (p = 0.961;0.972) and ADC (p = 0.961;0.972). The novel deep-learning-based reconstruction algorithm significantly reduces TA in breast DWI, while improving sharpness, reducing noise, and maintaining a comparable level of image quality, artifacts, contrast, and diagnostic confidence. DWI DL does not influence the quantifiable parameters. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis was performed to assess the staging/restaging performance of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in breast cancer.Methods: A comprehensive search was performed in PubMed databases for studies reporting the staging performance of F18-FDG PET/MRI in breast cancer from the inception of these databases to January 29, 2018. Eight studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of F18-FDG PET/MRI were calculated alongside 95% confidence intervals (CIs). A summary receiver operating characteristic curve (SROC) was plotted and the area under the SROC curve (AUC) was determined alongside the Q* index.Results: The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.98 (95% CI, 0.95-0.99), 0.87 (95% CI, 0.76-0.95), 4.59 (95% CI, 1.91-11.05), 0.03 (95% CI, 0.01-0.09), 203.07 (95% CI, 50.33-819.38), and 0.99, respectively. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of F18-FDG PET/MRI for staging in breast cancer were 0.91 (95% CI, 0.88-0.94), 0.95 (95% CI, 0.92-0.97), 11.28 (95% CI, 4.25-29.96), 0.07 (95% CI, 0.02-0.22), 286.46 (95% CI, 64.15-1279.17), and 0.99, respectively. The overall diagnostic accuracies (Q* index) of the staging performance of F18-FDG PET/MRI in breast cancer were 0.96 (patient-based analysis) and 0.95 (lesion-based analysis).Conclusion: F18-FDG PET/MRI has excellent diagnostic staging/restaging performance in patients with breast cancer, and thus should be considered for staging of patients with breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether combined Digital breast tomosynthesis and Automated breast volume scanner (DBT-ABVS) are comparable to Magnetic resonance imaging (MRI) in staging breast cancer.Methods: We retrospectively included seventy-three patients with histologically proven breast cancer who underwent preoperative DBT, ABVS and 1.5 T MRI in the period July 2015-July 2016. Two radiologists in consensus recorded the number, site and Breast imaging-reporting and data system (BI-RADS) category of breast findings during two independent reading strategies, i.e. DBT-ABVS vs. MRI. Using histology or 1-year follow up as the standard of reference, we calculated the accuracy for cancer of both imaging strategies. Bland-Altman analysis was used to evaluate the agreement between MRI vs. DBT or ABVS in cancer size assessment.Results: Patients showed a total of 160 lesions (108 malignant and 52 benign). Malignant lesions were unifocal, multifocal, multicentric and biltateral in 53, 15, 4 and 1 cases, respectively. Diagnostic accuracy of DBT-ABVS vs. MRI was comparable for all cancers (90.0% [95%C.I. 84.3-94.2] vs. 93.8% [95%C.I. 88.8-97.0], respectively). DBT-ABVS showed lower sensitivity and positive predictive values for additional disease (76.5% [95%C.I. 58.8-89.3] vs. 91.7% [95%C.I. 84.6-96.1], and 78.8% [95%C.I. 61.0-91.0] vs 93.4% [95%C.I. 86.9-97.3], respectively). Compared to MRI, ABVS + DBT missed 6 lesions, including two invasive cancers and one extensive intravascular invasion associated to ductal carcinoma in situ. Bland-Altman analysis showed ABVS to agree with MRI at a higher extent than DBT in assessing cancer size.Conclusions: Though less performing than MRI, DBT-ABVS showed acceptable diagnostic accuracy in staging breast cancer. This strategy might be used if MRI is unavailable or unfeasible. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively assess magnetic resonance imaging (MRI) findings that can predict lymphovascular invasion (LVI) in invasive breast cancer patients who were diagnosed with clinically negative axillary lymph nodes (LNs) preoperatively.Methods: This study included 140 lesions of 140 patients who underwent preoperative breast MRI and breast surgery, with omission of axillary LN dissection. Clinical characteristics and MRI findings were evaluated. The T2 signal intensity (SI) ratio (mean T2 SI of the tumor/mean T2 SI of the muscle), tumor apparent diffusion coefficient (ADC) value, peritumoral ADC value, peritumor-tumor ADC ratio (peritumoral maximum ADC value/tumor mean ADC value), and ADC value of the contralateral breast parenchyma were retrospectively assessed. Statistical analyses were performed to identify significant factors for predicting LVI. Inter-observer variability was calculated.Results: The tumor ADC value (all ages: p = 0.005; age ≤ 55: p < 0.001), peritumoral ADC value (age ≤ 55: p = 0.04), and peritumor-tumor ADC ratio (all ages: p < 0.001; age ≤ 55: p < 0.001) were significantly associated with LVI on univariate analysis. Multivariate logistic regression analysis revealed significant differences in the pathological size of the invasive component and the tumor ADC value for predicting LVI (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.41-8.32; p = 0.007; OR: 16.0; 95% CI: 1.89-136; p = 0.01, respectively). Inter-observer agreement was substantial for the tumor ADC value (intraclass correlation coefficient [ICC] = 0.77; 95% CI: 0.70-0.83) and the ADC value of the contralateral breast parenchyma (ICC = 0.68; 95% CI: 0.59-0.76). There was moderate agreement for the peritumoral ADC value (ICC = 0.53; 95% CI: 0.40-0.64) and the peritumor-tumor ADC ratio (ICC = 0.49; 95% CI: 0.35-0.61) and fair agreement for the T2 SI ratio (ICC = 0.30; 95% CI: 0.15-0.45).Conclusion: We found that the tumor ADC value, peritumoral ADC value, and peritumor-tumor ADC ratio were predictive MRI findings for LVI in patients aged ≤55. The tumor ADC value was the most significant predictor for LVI; moreover, inter-observer agreement for the tumor ADC value was substantial between two blinded observers with differences in interpretation experience. [ABSTRACT FROM AUTHOR]

• KS shows high diagnostic performance with low interobserver variability in patients with breast cancer. • Subcentimeter lesions and presence of personal breast cancer history are factors significantly associated with false-negative KS results. • Radiologists need to consider these factors in clinical practice as potential pitfalls for KS, which may be compensated by a multimodality approach combined with clinical evaluation. To investigate the factors associated with false-negative results in the diagnosis of breast cancer via breast magnetic resonance imaging (MRI) using the Kaiser score (KS). This institutional review board (IRB)-approved, single-center, retrospective study enrolled 219 consecutive histopathologically proven breast cancer lesions in 205 women who underwent preoperative breast MRI. Two breast radiologists evaluated each lesion according to the KS. The clinicopathological characteristics and imaging findings were also analyzed. Interobserver variability was assessed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was used to investigate factors associated with false-negative KS results for breast cancer diagnosis. Of 219 breast cancers, KS yielded 200 (91.3%) true-positive and 19 (8.7%) false-negative results. The interobserver ICC for the KS between the two readers was good, with a value of 0.804 (95% CI 0.751–0.846). Multivariate regression analysis revealed that small lesion size (≤1 cm) (adjusted OR 6.86, 95% CI 2.14–21.94, p = 0.001) and personal breast cancer history (adjusted OR 7.59, 95% CI, 1.55–37.23, p = 0.012) were significantly associated with false-negative KS results. Small lesion size (≤1 cm) and presence of personal breast cancer history are factors significantly associated with false-negative KS results. Our results suggest that radiologists should consider these factors in clinical practice as potential pitfalls of KS, which may be compensated for by a multimodal approach combined with clinical evaluation. [ABSTRACT FROM AUTHOR]

Purpose: To determine if breast MRI is useful for detecting additional or invasive sites of disease in patients initially diagnosed with pure DCIS.Materials and Methods: A retrospective review of women diagnosed with pure DCIS who underwent a breast MRI for evaluation of extent of disease was performed at a single institution from January 2013 to April 2015. Data analysis included imaging (mammography, ultrasound and MRI) and pathology characteristics (histology and biomarker status) of the primary DCIS as well as descriptors for the additional sites of disease incidentally found by breast MRI.Results: A total of 108 patients were diagnosed with pure DCIS during this time period. A breast MRI for staging was recommended for all patients. 76 patients had an MRI performed, ages ranging from 38 to 79 years old (median, 53 years); sizes ranging from 0.3 to 10cm (mean, 2.2cm). A total of 52 patients (68%) either had suspicious new finding(s) (n=27, 36%) or bigger tumor size than originally visualized on mammography (n=43, 57%). A total of twenty-seven patients (36%) had other MRI findings suspicious for additional sites of disease in either breast (four in the ipsilateral breast and twenty-three in the contralateral breast). From this group of patients, twenty-three (85%) patients underwent MRI-guided biopsy as recommended. The four patients who did not have the recommended MRI guided-biopsy either underwent total mastectomies or refused the biopsy. Six out of the twenty-three patients (26%) were diagnosed with an additional site of cancer (5 DCIS and 1 IDC) (7.9%, CI=3.7%, 16.2%). All of the six patients had contralateral disease (100%) and none had a second site of disease in the ipsilateral breast. The size of the additional sites of disease ranged from 0.4 to 8cm (mean, 3.1cm) and the size of the primary lesion in this selected group ranged from 0.1 to 10.9cm (mean, 5.6cm). Ages ranged from 44 to 63 years old (median, 52.5 years). Five out 6 patients (83%) presented with the first site of disease as pure DCIS with estrogen (ER) and progesterone (PR) receptors positive and one case (17%) was pure DCIS ER/PR- negative. The second incidental lesion found on MRI demonstrated 5 cases of contralateral pure DCIS and 1 case of contralateral invasive disease. From this group, we did not have the data for biomarker analysis for the second site of disease in 2 cases and 3 cases showed concordant biomarker status between the first and second sites of disease. The 1 case that presented with an invasive component in the contralateral side of the initially biopsy-proven pure DCIS had discordant biomarkers compared to the first site of disease: the first site of pure DCIS was ER/PR-negative and the second site of invasive ductal carcinoma (IDC) presented with ER/PR-positive status.Conclusion: From a total of 76 patients with recent diagnosis of pure DCIS who underwent staging breast MRI examination for diagnosis of additional sites of disease, approximately 8% (95% confidence interval=3.7%, 16.2%) was diagnosed with an additional site of cancer and 1.3% (95% confidence interval=0.2%, 7%) of the total cases had invasive disease in the additional sites with different biomarker status; changing their management and prognosis. [ABSTRACT FROM AUTHOR]

Purpose The impact of preoperative MRI on re-excisions and mastectomy rate is discussed controversially in the literature. Aim of this study was to evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries. Material and methods A total of 991 consecutive patients in the years 2009 and 2010 with 1036 primary breast cancers were retrospectively analyzed. Sixty percent (599 patients with 626 cancers) received preoperative breast MRI. Planned surgical procedures before and after MRI and numbers of repeated surgeries in patients with (MR+ ) and without preoperative MRI (MR−) were compared. Results The result of preoperative MRI changed the surgical procedure in 25% (157/626) of the cases. In 81% (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n = 122) or further biopsy could be prevented (n = 5). Mastectomy rates did not differ between MR+ and MR- group (39% vs. 39%). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p < 0.05). Conclusion Preoperative MRI could lower the chance for repeated surgery in patients with primary breast cancer. The rate of mastectomy did not differ between patients undergoing preoperative MRI and those who did not. [ABSTRACT FROM AUTHOR]

Objectives: To enhance the accurate prediction of the response to neoadjuvant chemotherapy (NAC) in breast cancer patients by using a quantitative analysis of dynamic enhancement magnetic resonance imaging (DCE-MRI).Materials and Methods: A dataset of 57 cancer patients with breast DCE-MR images acquired before NAC was used. Among them, 47 patients were Responders, and 10 patients were non-Responders based on the RECIST criteria. The breast regions were segmented on the MR images, and a total of 158 radiomic features were computed to represent the morphologic, dynamic, and the texture of the tumors as well as the background parenchymal features. The optimal subset of features was selected using evolutionary based Wrapper Subset Evaluator. The classifier was trained and tested using a leave-one-out cross-validation (LOOCV) method to classify Responder and non-Responder cases. The area under a receiver operating characteristic curve (AUC) was computed to assess the classifier performance. An additional independent dataset with 46 patients was also included to validate the results.Results: The evolutionary algorithm (EA)-based method identified optimal subsets comprising 12 image features that were fit for classification for the main cohort. Following the same feature selection procedure, the independent validation dataset produced 11 image features, 7 of which were identical to those from the main cohort. The classifier based on the features yield a LOOCV AUC of 0.910 and 0.874 for the main and the reproducibility study cohort, respectively. If the optimal features in the main cohort were utilized to test performance on the reproducibility cohort, the classifier generated an AUC of 0.713. While the features developed in the reproducibility cohort were applied to test the main cohort, the classifier achieved an AUC of 0.683. The AUC of the averaged receiver operating characteristic (ROC) curve for the two data cohort was 0.703.Conclusions: This study demonstrated that quantitative analyses of radiomic features from pretreatment breast DCE-MRI data could be used as valuable image markers that are associated with tumor response to NAC. [ABSTRACT FROM AUTHOR]

Objectives: To perform a large-scale multicenter post-marketing surveillance study for analyzing diagnostic effectiveness and safety of intravenous (IV) gadoteric acid (Dotarem®) in magnetic resonance (MR) mammography under daily practice conditions.Materials and Methods: Patients underwent high-resolution MR mammography with gadoteric acid in 15 German centers. Radiologists used a standardized questionnaire to report data including patient demographics and medical history, characteristics of MR examination and results in terms of diagnosis and safety for the patient.Results: A total of 1537 patients were examined. In 99.2% of all patients, a diagnosis was established. In 91.6% of all patients, image quality was excellent or good. Histopathological examinations were performed for 232 of 1537 patients (15.1%) with invasive ductal carcinoma being the most frequent diagnosis (109 patients, 47.0%). Based on histopathology as the standard of reference, IV gadoteric acid-enhanced MR mammography confirmed diagnoses of invasive ductal carcinoma in 93.5% of the patients. Adverse drug reactions occurred in 5 of 1537 patients (0.3%) and were classified as serious in one case (tachycardia, dysphagia, urticaria, rash). All patients with adverse drug reactions fully recovered after the examination.Conclusion: This noninterventional surveillance study shows IV gadoteric acid to be a safe and effective contrast agent for use in MR mammography. [ABSTRACT FROM AUTHOR]

Background: Achieving pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) improves survival outcomes for breast cancer patients. Currently, conventional histopathological biomarkers predicting such responses are inconsistent. Studies investigating radiomic texture analysis from breast magnetic resonance imaging (MRI) to predict pCR have varied radiomic protocols introducing heterogeneity between results. Thus, the efficacy of radiomic profiles compared to conventional strategies to predict pCR are inconclusive.Purpose: Comparing the predictive accuracy of different breast MRI radiomic protocols to identify the optimal strategy in predicting pCR to NAC.Material and Methods: A systematic review and network meta-analysis was performed according to PRISMA guidelines. Four databases were searched up to October 4th, 2021. Nine predictive strategies were compared, including conventional biomarker parameters, MRI radiomic analysis conducted before, during, or after NAC, combination strategies and nomographic methodology.Results: 14 studies included radiomic data from 2,722 breast cancers, of which 994 were used in validation cohorts. All MRI derived radiomic features improved predictive accuracy when compared to biomarkers, except for pre-NAC MRI radiomics (odds ratio [OR]: 0.00; 95 % CI: -0.07-0.08). During-NAC and post-NAC MRI improved predictive accuracy compared to Pre-NAC MRI (OR: 0.14, 95 % CI: 0.02-0.26) and (OR: 0.26, 95 % CI: 0.07-0.45) respectively. Combining multiple MRIs did not improve predictive performance compared to Mid- or Post-NAC MRIs individually.Conclusion: Radiomic analysis of breast MRIs improve identification of patients likely to achieve a pCR to NAC. Post-NAC MRI are the most accurate imaging method to extrapolate radiomic data to predict pCR. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the latest breast imaging reporting and data system (BI-RADS) magnetic resonance imaging (MRI) (5th edition) descriptors and non BI-RADS MRI factors that contribute to differentiation between mucinous carcinomas (MCs) and fibroadenomas (FAs). Materials and Methods: This retrospective study included 27 patients with P-MCs or M-MCs similar to P-MCs and 22 patients with FAs who underwent breast MRI between October 2008 and July 2014 at our institution. Definitive histopathological diagnoses were made for all of the MCs and FAs. The latest BI-RADS MRI descriptors for abnormal enhancement, including maximum diameter, shape (irregular or round/oval), margin (irregular or circumscribed), rim enhancement (present or absent), dark internal septation (absent or present), delayed internal enhancement (heterogeneous or homogeneous), and the time-intensity curve pattern (not persistent or persistent) were evaluated. As additional non BI-RADS MRI factors related to differentiation between MC and FA, age, signal intensity in the T2-weighted image (high or not high), extent of lobulation (strong or weak), enhancing internal septation (present or absent), and the apparent diffusion coefficient value were also evaluated. One radiologist retrospectively evaluated interpreted MR findings and analyzed the findings. Statistically significant findings were identified through univariate and multivariate analyses. Then, three blinded radiologists reviewed the MR images where MR findings had shown a significant association with outcomes during univariate analyses. Independently, the three blinded readers reviewed the MR images for the evaluation of inter-observer variability, and then arrived at a consensus for the evaluation of observer performance. Observer performance and inter-observer variability were determined via a receiver-operating-characteristic curve analysis and weighted k statistics. The sensitivity, specificity, and accuracy of each of the MR findings were calculated. Results: Univariate analyses showed that irregular margins were observed more frequently in MCs than in FAs (11/27, 41% vs. 1/22, 0.5%, p<0.05). MCs also showed rim enhancement, delayed heterogeneous enhancement, and enhancing internal septation more frequently than FAs (p<0.05). FAs showed circumscribed margins more frequently than MCs (21/22, 95% vs. 16/27, 59%, p<0.05). FAs also showed dark internal septation more frequently than MCs (18/22, 82% vs. 3/27, 11%, p<0.05). In multivariate analyses, the most significant feature in lesion characterization was delayed heterogeneous enhancement. In the blinded reading, a combination of irregular margin and delayed heterogeneous enhancement showed the highest sensitivity (96.3%) and accuracy (87.8%). Enhancing internal septation showed the highest specificity (90.9%). The κ values with confidence ratings for differentiation between MCs and FAs were 0.63-0.67, which showed substantial agreement among the three radiologists. Conclusions: The combination of irregular margin and delayed heterogeneous enhancement and enhancing internal septation were significant findings for differentiation between P-MC or M-MC similar to P-MC and FA. [ABSTRACT FROM AUTHOR]

Purpose: Ductal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery.Materials and Methods: Patients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components.Results: Of the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens.Conclusion: Invasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates use of an abbreviated magnetic resonance imaging protocol with T2-weighted imaging in detecting biopsy-proven unifocal breast cancer.Materials and Methods: This is an institutional review board approved retrospective study of patients with biopsy-proven unifocal breast cancer (88% invasive; 12% in situ) undergoing magnetic resonance imaging. In three separate sessions, three breast imagers evaluated (1) T1-weighted non-contrast, post-contrast and post-contrast subtracted images, (2) T1-weighted images with clinical history and prior imaging, and (3) T1-weighted images and T2-weighted images with clinical history and prior imaging. Protocols were compared for cancer detection, reading time and lesion conspicuity. An independent breast radiologist retrospectively analyzed initial enhancement ratio of cancers and retrospectively reviewed lesion morphology and final pathology.Results: All 107 cancers were identified at first protocol by at least one reader; five cancers were missed by either one or two readers. One cancer was missed by one reader at protocols two and three. Mean percentage detection for protocol one was 97.8%; protocol two, 99.4%, protocol three, 99.4%. T2-weighted images did not alter cancer detection but increased lesion conspicuity for 2/3 readers. 3/5 missed lesions were low grade cancers. Initial enhancement ratio was positively associated with increasing tumor grade (p=0.031) and pathology (p=0.002). Reader interpretation time decreased and lesion conspicuity increased as initial enhancement ratio increased.Conclusion: Abbreviated magnetic resonance imaging has high rate of detection for known breast cancer and short interpretation time. T2 weighted imaging increased lesion conspicuity without altering detection rate. Initial enhancement ratio correlated with invasive disease and tumor grade. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the use of a newly introduced interpretation model for breast nonmass enhancement (NME, defined as an area of enhancement without a three-dimensional, space-occupying lesion) with the use of the standard interpretation method based on BI-RADS.Materials and Methods: Two expert and two less-experienced breast imaging radiologists performed reading sessions of 86 malignant and 64 benign NME lesions twice. First, radiologists characterized NME using BI-RADS descriptors and assessed the likelihood of malignancy and need for a biopsy. Second, the likelihood of malignancy and need for a biopsy were assessed with the use of the model, in which three-step characterization of morphological features were performed: (1) selection of distribution modifiers, (2) homogeneous vs. heterogeneous internal enhancement (IE) pattern, and (3) evaluation of presence of "clumped", "clustered ring enhancement (CRE)", and "branching" IE signs. Multireader-multicase receiver operating characteristic analysis was used to evaluate observers' performances. Univariate and multivariate logistic regression analyses were performed for morphology descriptors.Results: With use of the model, average Az of less-experienced radiologists (0.77-0.83; p=0.013) and average sensitivity of all radiologists (96.2-98.2%; p=0.007) improved significantly. NPV also improved but nonsignificantly (81.1-91.9%; p=0.055). Multivariate analyses of the second reading showed branching, clumped, and CRE signs to be significant predictors of malignancy in the results of 3, 2, and 2 readers, respectively.Conclusion: The three-step interpretation model for NME has the potential to improve less-experienced radiologists' performances, making them comparable to expert breast imagers. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether there were suspicious criteria on the initial MRI in BIRADS 3 lesions. To analyze the value of "blooming sign" as an additional criterion for malignancy.Materials and Methods: In this retrospective study the lesion morphological and enhancement characteristics were analyzed. The "blooming sign" (BS), defined as the lesion size increase between the early and the late phase after gadolinium was assessed. We determined the optimal cut-off value for the BS to distinguish benign and malignant breast lesions.Results: 100 lesions were classified BIRADS 3 in 75 patients (12%). Four of the five malignant lesions had suspicious BIRADS criteria on the index MRI. 45 lesions were stable and 30 lesions resolved spontaneously during the follow-up MRI. The optimal cut-off value for the BS was 8.54% with 100% sensitivity, 94% specificity, 44% positive and 100% negative predictive values. Using reclassification rule to upgrade benign BIRADS lesions with suspicious BS feature and downgrade suspicious BIRADS lesions with benign BS feature increased MRI specificity (89%), sensitivity (100%) while preserving NPV (100%).Conclusions: This study showed the suggestive part of classified BIRADS 3 lesions. The blooming sign seems to be a good additional parameter to increase MRI specificity when associated to BIRADS criteria. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of an automated computer-aided detection (CAD) system to detect breast cancers that were overlooked or misinterpreted in a breast MRI screening program for women at increased risk.Methods: We identified 40 patients that were diagnosed with breast cancer in MRI and had a prior MRI examination reported as negative available. In these prior examinations, 24 lesions could retrospectively be identified by two breast radiologists in consensus: 11 were scored as visible and 13 as minimally visible. Additionally, 120 normal scans were collected from 120 women without history of breast cancer or breast surgery participating in the same MRI screening program. A fully automated CAD system was applied to this dataset to detect malignant lesions.Results: At 4 false-positives per normal case, the sensitivity for the detection of cancer lesions that were visible or minimally visible in retrospect in prior-negative examinations was 0.71 (95% CI=0.38-1.00) and 0.31 (0.07-0.59), respectively.Conclusions: A substantial proportion of cancers that were misinterpreted or overlooked in an MRI screening program was detected by a CAD system in prior-negative examinations. It has to be clarified with further studies if such a CAD system has an influence on the number of misinterpreted and overlooked cancers in clinical practice when results are given to a radiologist. [ABSTRACT FROM AUTHOR]

Objectives: Readout-segmented echo planar imaging (rs-EPI) significantly reduces susceptibility artifacts in diffusion-weighted imaging (DWI) of the breast compared to single-shot EPI but is limited by longer scan times. To compensate for this, we tested a new simultaneous multi-slice (SMS) acquisition for accelerated rs-EPI.Materials and Methods: After approval by the local ethics committee, eight healthy female volunteers (age, 38.9 ± 13.1 years) underwent breast MRI at 3T. Conventional as well as two-fold (2× SMS) and three-fold (3× SMS) slice-accelerated rs-EPI sequences were acquired at b-values of 50 and 800 s/mm(2). Two independent readers analyzed the apparent diffusion coefficient (ADC) in fibroglandular breast parenchyma. The signal-to-noise ratio (SNR) was estimated based on the subtraction method. ADC and SNR were compared between sequences by using the Friedman test.Results: The acquisition time was 4:21 min for conventional rs-EPI, 2:35 min for 2× SMS rs-EPI and 1:44 min for 3× SMS rs-EPI. ADC values were similar in all sequences (mean values 1.62 × 10(-3)mm(2)/s, p=0.99). Mean SNR was 27.7-29.6, and no significant differences were found among the sequences (p=0.83).Conclusion: SMS rs-EPI yields similar ADC values and SNR compared to conventional rs-EPI at markedly reduced scan time. Thus, SMS excitation increases the clinical applicability of rs-EPI for DWI of the breast. [ABSTRACT FROM AUTHOR]

Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening. [ABSTRACT FROM AUTHOR]

Objective: To investigate if the presence of metallic markers (markers) influences the diagnostic accuracy of preoperative breast MRI for the prediction of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients.Materials and Methods: In this single-center, retrospective, observational study approved by the IRB of our institution, we included all consecutive patients that underwent preoperative breast MRI after completion of NAC (Mean 4,4 days ± 15,9). The presence or absence of markers, the type of markers, the size and type of artefact on each MRI sequence were recorded. Two radiologists blinded to histopathological results and to each other's findings evaluated all MRI examinations for presence or absence of complete response. Pathology was the standard of reference. Diagnostic performance of MRI for prediction of pCR in the presence or absence of markers and also between two most represented markers brands (O'Twist and UltraClip) were compared using Chi-squared tests or equivalents.Results: Ninety-three patients (mean age 48 ± 11 years) were included in this study. Nineteen of them had no markers and 74 had 108 markers. Sensitivity and specificity of MRI for the prediction of pCR were 0.73 and 0,81 for patients with and 0.67 and 0.90 for patients without markers (p < 0.05).There was no statistical difference in the performance of MRI for the two different types of markers studied.Conclusion: Diagnostic performance of pre-operative MRI after NAC for the prediction of pCR did not differ statistically in the presence or absence of metallic markers nor between the two markers' brands studied. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate any association between tumor apparent diffusion coefficient (ADC) values and axillary lymph node metastasis (ALNM) in early-stage invasive ductal carcinoma.Materials and Methods: Records of 270 invasive ductal carcinoma patients with stages T1 and T2 disease who underwent breast magnetic resonance imaging, including diffusion-weighted imaging with b values of 0 and 1000s/mm(2) were reviewed retrospectively. The tumor ADC values were analyzed for their utility in predicting ALNM using multivariate regression analysis and receiver operating characteristic (ROC) curve analysis.Results: Of the 270 patients, 58 (21.5%) experienced ALNM. The mean tumor ADC values were significantly lower in patients with ALNM than in those without metastasis (0.880 × 10(-3) vs. 0.999 × 10(-3)mm(2)/s, P<0.001). A ROC curve demonstrated a tumor ADC value of 0.991 × 10(-3)mm(2)/s to be the optimal cut-off for predicting ALNM. In a multivariate analysis, lower tumor ADC (≤ 0.991 × 10(-3)mm(2)/s; adjusted odds ratio (OR)=5.861, P<0.001), large tumor size (>2 cm; adjusted OR=3.156, P=0.002) and the presence of lymphovascular invasion (adjusted OR=4.125, P<0.001) were independent variables associated with ALNM. When tumor ADC value was added to known risk factors (i.e., tumor size and lymphovascular invasion), a significant improvement in the accuracy of risk prediction for axillary node metastasis was shown (c-statistic=0.758 vs. 0.816, P=0.026).Conclusion: In early-stage invasive ductal carcinoma, lower tumor ADC values are associated with the presence of ALNM. [ABSTRACT FROM AUTHOR]

Objective: To measure background parenchymal enhancement (BPE) and compare with other contrast enhancement values and diffusion-weighted MRI parameters in healthy and cancerous breast tissue at the clinical level.Materials and Methods: This HIPAA-compliant, IRB approved retrospective study enrolled 77 patients (38 patients with breast cancer - mean age 51.8 ± 10.0 years; 39 high-risk patients for screening evaluation - mean age 46.3 ± 11.7 years), who underwent contrast-enhanced 3T breast MRI. Contrast enhanced MRI and diffusion-weighted imaging were performed to quantify BPE, lesion contrast enhancement, and apparent diffusion coefficient (ADC) metrics in fibroglandular tissue (FGT) and lesions.Results: BPE did not correlate with ADC values. Mean BPE for the lesion-bearing patients was higher (43.9%) compared to that of the high-risk screening patients (28.3%, p=0.004). Significant correlation (r=0.37, p<0.05) was found between BPE and lesion contrast enhancement.Conclusion: No significant association was observed between parenchymal or lesion enhancement with conventional apparent diffusion metrics, suggesting that proliferative processes are not co-regulated in cancerous and parenchymal tissue. [ABSTRACT FROM AUTHOR]

Objective Our purpose was to evaluate whether breast cancer with high metabolic–perfusion ratio would be associated with poor histopathologic prognostic factors and whether triple negative breast cancer (TNBC) would show high metabolic–perfusion ratio compared to non-triple negative breast cancer (non-TNBC). Methods From March 2011 to November 2011, 67 females with invasive ductal carcinoma of breast who underwent both MRI and 18F-FDG PET/CT were included. Perfusion parameters including Ktrans, Kep and Ve were acquired from Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Metabolic parameters including the standardized uptake value (SUV) and volumetric metabolic parameters including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained from F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). Results In non-TNBC, SUVmax was significantly correlated with Kep ( ρ = 0.298, p = 0.036) and Ve ( ρ = −0.286, p = 0.044). In TNBC, there was no significant correlation between all perfusion and metabolic parameters. Compared to non-TNBC, higher SUVmax (10.2 vs 5.3, p < 0.001), higher SUVmax/Ktrans (56.02 vs 20.3, p < 0.001), higher MTV50/Ktrans (7.8 vs 16.54, p < 0.001), higher TLG50/Ktrans (36.49 vs 12.3, p < 0.001), higher TLG50/Ve (91.34 vs 27.1 p = 0.022) were significantly correlated with TNBC. Lower Ktrans (0.17 vs 0.29, p = 0.017) and lower Ve (0.29 vs 0.41, p = 0.011) were also significantly associated TNBC. Conclusion While several perfusion parameters and metabolic parameters were correlated in non-TNBC, they were not correlated in TNBC. TNBC showed higher metabolic–perfusion ratios compared to non-TNBC. [ABSTRACT FROM AUTHOR]

Objectives While 3 T breast magnetic resonance imaging has increased in use over the past decade, there is little data comparing its use for assessing ductal carcinoma in situ (DCIS) versus 1.5 T. We sought to compare the accuracies of DCIS extent of disease measures on pre-operative 3 T versus 1.5 T MRI. Methods This institutional review board-approved prospective study included 20 patients with ductal carcinoma in situ diagnosed by core needle biopsy (CNB) who underwent pre-operative breast MRI at both 3 T (resolution = 0.5 mm × 0.5 mm × 1.3 mm) and 1.5 T (0.85 mm × 0.85 mm × 1.6 mm). All patients provided informed consent, and the study was HIPPA compliant. Lesion sizes and imaging characteristics (morphologic and kinetic enhancement) were recorded for the 3 T and 1.5 T examinations. Lesion size measures at both field strengths were correlated to final pathology, and imaging characteristics also were compared. Results Of the initial cohort of 20 patients with CNB-diagnosed DCIS, 19 underwent definitive surgery. Median DCIS sizes of these 19 patients were 6 mm (range: 0–67 mm) on 3 T, 13 mm (0–60 mm) on 1.5 T, and 6 mm (0–55 mm) on surgical pathology. Size correlation between MRI and pathology was higher for 3 T (Spearman's ρ = 0.66, p = 0.002) than 1.5 T ( ρ = 0.36, p = 0.13). In 10 women in which a residual area of suspicious enhancement was identified on both field strengths, there was agreement of morphologic description (NME vs. mass) in nine, and no significant difference in dynamic contrast enhanced kinetics at 3 T compared to 1.5 T. Conclusions Pre-operative breast MRI at 3 T provided higher correlation with final pathology size of DCIS lesions compared to 1.5 T, and may be more accurate for assessment of disease extent prior to definitive surgery. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the influence of the amount of fibroglandular breast tissue (FGT) and background-parenchymal enhancement (BPE) on lesion detection, quantitative analysis of normal breast tissue and of breast lesions on DWI. Materials and methods IRB approved this retrospective study on focal findings at contrast-enhanced (CE) breast MR and DWI performed during July–December 2011. Patients with cysts, previous irradiation, silicone implants and current chemotherapy were excluded. DWI with fat suppression was acquired before dynamic acquisition ( b factors: 0.1000 s/mm 2 ) using 1.5 and 3 T scanners. Using correlation with dynamic and T2 images, ROIs were drawn free-hand within the borders of any visible lesion and in contralateral normal breast. Fisher's exact test to evaluate visibility and Wilcoxon-rank-sum test for comparison of ADC values were used. The amount of FGT and BPE was visually assessed by concurrent MRI. Analysis was stratified by menopausal status. Results 25/127 (20%) lesions were excluded for technical reasons. 65/102 (64%) lesions were visible on DWI (median diameter: 1.85 cm). Mass lesions ( M ) were more visible (43/60 = 72%) than non-mass enhancement (NME) (22/42 = 52%) and malignant lesions were more visible (55/72 = 76%) than benign (10/30 = 33%). BPE and FGT did not influence visibility of M ( p = 0.35 and p = 0.57 respectively) as well as of NME ( p = 0.54 and p = 0.10). BPE and FGT did not influence visibility of malignant ( p = 0.96 and p = 1.0) and benign lesions ( p = 1.0 and p = 0.10). Results were confirmed adjusting for menopausal status. The ADC value of normal breast tissue was not influenced by BPE, while it was lower in predominantly fatty breasts compared to dense ones ( p = 0.002). Conclusions FGT affects the quantitative evaluation of ADC in normal breast tissue whereas BPE does not. Furthermore, both BPE and FGT do not influence visibility of benign or malignant findings, including both mass lesions and non-mass enhancement, on DWI. [ABSTRACT FROM AUTHOR]

Objective To correlate capillary density of breast lesions using the markers D2-40, CD31, and CD34 with early and late enhancement of magnetic resonance mammography (MRM). Materials and methods The local ethics committee approved this study, and informed consent was available from all patients. The study included 64 women with 66 histologically proven breast lesions (41 malignant, 25 benign). MR-enhancement 1 min after contrast medium administration was determined in the tumor ( I t1 / I t0 ratio) and in comparison to the surrounding tissue ( I t1 / I t1-fat ratio). Capillary density was quantified based on immunohistological staining with D2-40, CD31, and CD34 in breast tumors and surrounding breast tissue. Mean capillary densities were correlated with contrast enhancement in the tumor and surrounding breast tissue. The Kruskal–Wallis test was used to test whether lesions with different MR enhancement patterns differed in terms of capillary density. Results For CD34, there was statistically significant correlation between capillary density and tumor enhancement ( r = 0.329, p = 0.012), however not for the malignant or benign groups separately. Mean vessel number identified by staining with D2-40 and CD31 did not correlate significantly with tumor enhancement (D2-40: r = −0.188, p = 0.130; CD31: r = 0.095, p = 0.448). There were no statistically significant differences in capillary density between breast lesions with delayed enhancement or a plateau and lesions showing washout (Kruskal–Wallis test. D2-40: p = 0.173; CD31: p = 0.647; CD34: p = 0.515). Conclusion Of the three markers tested, CD34 showed best correlation between early contrast enhancement on MRM and capillary density. Further studies are necessary to clearly demonstrate an association between capillary density and contrast enhancement in breast tumors and surrounding tissue. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the added value of ultrafast MRI in abbreviated breast MRI (AB-MRI) surveillance in women with a personal history of breast cancer (PHBC).Method: Between September 2017 and November 2019, consecutive postoperative surveillance AB-MRIs with ultrafast MRIs (20 images with a 4.0-second temporal resolution using 4D time-resolved angiography with keyhole technique) were retrospectively collected. Four blinded radiologists independently classified the Breast Imaging Reporting and Data System (BI-RADS) category for AB-MRI alone versus the combined protocol (AB-MRI + ultrafast MRI). Readers were recommended to change BI-RADS category according to the time to enhancement cut-off of 12 s in ultrafast MRI. McNemar test and generalized estimation equation model were used to compare the diagnostic performances.Results: A total of 867 MRI examinations in 867 women (mean age ± standard deviation, 51 years ± 8) were evaluated. The sensitivity of both protocols among all readers was the same, at 90% (9/10). Addition of ultrafast MRI improved the specificity (a mean of 95.3% vs. 88.6 %, p < 0.001 for all readers) and positive predictive value 1 (PPV1) (a mean of 21% vs. 10%, p < 0.001 for all readers) compared to AB-MRI alone. Downgrading BI-RADS category 3 to 2 in four readers in a mean of 6.7% (57 of 857) of negative or benign findings was the main reason for the improved specificity and PPV1.Conclusion: Addition of ultrafast MRI to AB-MRI improved the specificity and PPV1 by reducing unnecessary short-term follow-ups without compromising sensitivity in postoperative surveillance. [ABSTRACT FROM AUTHOR]

Aim The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype). Materials and methods Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response - pCR was assessed (Mandard classification). Results Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p < 0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC = 0.9) and in the HER2+ subgroup (AUC = 0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC = 0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC = 0.797 and 0.761). Conclusion The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to contribute to the standardization of the numeric positive enhancement integral (PEI) values in breast parenchyma, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) and to evaluate the significance of the difference in PEI values between IDC and parenchyma, DCIS and parenchyma and IDC and DCIS. Materials and Methods: In the prospective trial, we analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of 60 consecutive patients with histologically confirmed unilateral DCIS (n =30) and IDC (n =30) and defined the PEI values (range; mean±SD) for the lesions and the breast parenchyma. Tumor-to-non-tumor (T/NT) ratios were calculated for DCIS and IDC and compared. PEI color maps (PEICM) were created. The differences in PEI values between IDC and parenchyma and between DCIS and parenchyma were tested according to t-test. Analysis of variance (ANOVA) was used to test the differences between the mean PEI values of parenchyma, DCIS and IDC. Results: IDC showed highly statistically different PEI numeric values compared to breast parenchyma (748.7±32.2 vs. 74.6±17.0; p <0.0001). The same applied to the differences in the group of patients with DCIS (428.0±25.0 vs. 66.0±10.6; p <0.0001). The difference between IDC, DCIS and parenchyma were also considered highly statistically significant (p <0.0001) and so were the T/NT ratios for IDC and DCIS (10.1±2.4 vs. 6.6±1.4; p <0.0001). Conclusions: PEI numeric values may contribute to differentiation between invasive and in situ breast carcinoma. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate whether the degree of background parenchymal enhancement affects the accuracy of tumor size estimation based on breast MRI. Methods: Three hundred and twenty-two patients who had known breast cancer and underwent breast MRIs were recruited in our study. The total number of breast cancer cases was 339. All images were assessed retrospectively for the level of background parenchymal enhancement based on the BI-RADS criteria. Maximal lesion diameters were measured on the MRIs, and tumor types (mass vs. non-mass) were assessed. Tumor size differences between the MRI-based estimates and estimates based on pathological examinations were analyzed. The relationship between accuracy and tumor types and clinicopathologic features were also evaluated. Results: The cases included minimal (47.5%), mild (28.9%), moderate (12.4%) and marked background parenchymal enhancement (11.2%). The tumors of patients with minimal or mild background parenchymal enhancement were more accurately estimated than those of patients with moderate or marked enhancement (72.1% vs. 56.8%; p =0.003). The tumors of women with mass type lesions were significantly more accurately estimated than those of the women with non-mass type lesions (81.6% vs. 28.6%; p <0.001). The tumor of women negative for HER2 was more accurately estimated than those of women positive for HER2 (72.2% vs. 51.6%; p =0.047). Conclusion: Moderate and marked background parenchymal enhancement is related to the inaccurate estimation of tumor size based on MRI. Non-mass type breast cancer and HER2-positive breast cancer are other factors that may cause inaccurate assessment of tumor size. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose of this study was to determine the factors that contribute to the differentiation between phyllodes tumors (PTs) and fibroadenomas (FAs) on MR imaging. Materials and methods: This retrospective study included 19 PTs and 18 FAs with ≥2cm diameter. The presence or absence of a capsule and internal septum, the extent of lobulation, and the apparent diffusion coefficient (ADC) values were determined. The presence or absence of a cystic component, the time–intensity curve, and the signal intensity on delayed-phase contrast-enhanced T1WI were also evaluated in 31 patients (16 PTs and 17 FAs) who underwent a contrast-enhanced study. Results: Cystic components were seen in 10 of the 16 PTs (63%) and in 4 of the 17 FAs (24%; P =0.03). The PTs showed strong lobulation more frequently compared to the FAs (14/19 [74%] vs. 7/18 [39%], respectively; P =0.04). Though there was no significant difference, PT tended to be heterogeneous more frequently on the delayed phase of the contrast-enhanced T1WI compared to the FA (11/16 [69%] vs. 7/17 [41%], respectively). No significant difference was found in the other findings. Conclusions: Although PTs and FAs show similar MR findings, the presence of a cystic component, strong lobulation, and heterogeneity on delayed-phase contrast-enhanced T1WI suggests a PT. [Copyright &y& Elsevier]

Abstract: Objectives: To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors. Materials and Methods: The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases. Results: In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898]. Conclusions: We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer. [Copyright &y& Elsevier]

Abstract: Objectives: To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated. Results: Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p <0.001). Agreement between both techniques was low (k =0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes. Conclusions: Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign. [Copyright &y& Elsevier]

Abstract: Purpose: The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions. Materials and methods: A retrospective review of 308 female patients (mean age 50±20) who underwent breast MRI with 1.5T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n =80; follow-up n =45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n =80; dense breast n =103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT). Results: 59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%. Conclusion: Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value. [Copyright &y& Elsevier]

Abstract: Purpose: This study was aimed to assess the role of magnetic resonance imaging (MRI) in the evaluation of the papillary lesions of the breast and their morphological relationship with the mammary ducts. The potential diagnostic contributory role of ductal oriented protocols to conventional dynamic magnetic resonance examination was also explored. Materials and methods: Retrospective data were collected from 46 patients who had been diagnosed with papillary breast lesions and undergone magnetic resonance examination. The presence of dilated ducts and their morphological relation with the lesion were recorded. Lesions were classified as follows: papilloma, papillomatosis and malignant papillary lesion. Statistical difference between groups was studied for each morphological and dynamic lesion characteristic. Results: Dilated ducts and characteristics of intraductal material can be identified by magnetic resonance imaging. Certain MRI findings such as a mass with crescentic peripheral fluid or focal intraductal mass on T2 weighted images may suggest the presence of an intraductal/papillary lesion. In this respect, non-fatsat T2 weighted images appear particularly useful. There was a significant difference between papilloma and papillomatosis with regard to segmental and heterogeneous contrast enhancement (p <0.05 for both comparisons). In addition, there was a significant difference between papillomas and carcinomas with regard to homogenous, heterogeneous and segmental contrast enhancement (p <0.05 for all). On the other hand, papillomatosis and carcinoma did not differ significantly in terms of any of the morphological or dynamical MR criteria compared. Conclusion: Papillary lesions can be detected by MRI. Despite some overlaps in MRI findings between carcinoma, papilloma and papillomatosis, MRI may help differentiate these lesions. Major benefit of retroareolar imaging appears to arise from its ability to demonstrate ductal relation and extension of contrast enhanced regions. [Copyright &y& Elsevier]

Abstract: Objective: To verify the capacity of targeted ultrasound (US) to identify additional lesions detected on breast magnetic resonance imaging (MRI), but occult to initial mammography, US and clinical examinations. Methods: This prospective study included 68 additional relevant breast lesions identified on MRI of 49 patients. As an inclusion criterion, breast US and mammography were required and performed up to six months before MRI. These lesions were then subjected to targeted “second-look” US up to 2 weeks after MRI, performed by one or two radiologists with expertise on breast imaging. Lesions were evaluated according to the established Breast Imaging Report and Data System (BI-RADS) lexicon. Results: Targeted US identified 46/68 (67.6%) lesions revealed by MRI. No significant associations were observed between US identification and the type of lesion, dimensions, morphological characteristics and enhancement pattern according to MRI findings. Targeted US identified 100% of BI-RADS category 5 lesions, 90% of category 4 lesions, and just over 50% of category 3 lesions (p <0.05). There was significant agreement (p <0.001) between MRI and US BI-RADS classification for all three categories. Conclusion: Targeted US can identify a large proportion of the lesions detected by breast MRI, especially those at high risk of malignancy, when performed by a professional with experience in both breast US and MRI. [Copyright &y& Elsevier]

Abstract: Objective: To investigate whether the addition of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced MRI (DCE-MRI) improves diagnostic performance in predicting pathologic response and residual breast cancer size following neoadjuvant chemotherapy. Materials and methods: A total of 78 consecutive patients who underwent preoperative breast MRI with DWI following neoadjuvant chemotherapy were enrolled. DWI was performed on a 1.5T system with b values of 0 and 750s/mm. or on a 3T system with b values of 0 and 800 or 0 and 1000s/mm. The images on DCE-MRI alone, DWI alone, and DCE-MRI plus DWI were retrospectively reviewed. We evaluated the diagnostic performances of the three MRI protocols for the detection of residual cancer. The tumor size as predicted by MRI was compared with histopathologic findings. Apparent diffusion coefficient (ADC) values were also compared between the groups with and without residual cancer. Results: Of the 78 patients, 59 (75.6%) had residual cancer. For detection of residual cancer, DCE-MRI plus DWI had higher specificity (80.0%), accuracy (91.0%), and PPV (93.2%) than DCE-MRI or DWI alone (P =0.004, P =0.007, and P =0.034, respectively). The ICC values for residual cancer size between MRI and histopathology were 0.891 for DCE-MRI plus DWI, 0.792 for DCE-MRI, and 0.773 for DWI. ADC values showed no significant differences between residual cancer and chemotherapeutic changes (P =0.130). Conclusions: The addition of DWI to DCE-MRI significantly improved diagnostic performance in predicting pathologic response and residual breast cancer size after neoadjuvant chemotherapy. [Copyright &y& Elsevier]

Abstract: Purpose: To compare the performance of PET/MRI imaging using MR attenuation correction (MRAC) (DIXON-based 4-segment -map) in breast cancer patients with that of PET/CT using CT-based attenuation correction and to compare the quantification accuracy in lesions and in normal organ tissues. Methods: A total of 36 patients underwent a whole-body PET/CT scan 1h after injection and an average of 62min later a second scan using a hybrid PET/MRI system. PET/MRI and PET/CT were compared visually by rating anatomic allocation and image contrast. Regional tracer uptake in lesions was quantified using volumes of interest, and maximal and mean standardized uptake values (SUVmax and SUVmean, respectively) were calculated. Metabolic tumor volume (MTV) of each lesion was computed on PET/MRI and PET/CT. Tracer uptake in normal organ tissue was assessed as SUVmax and SUVmean in liver, spleen, left ventricular myocardium, lung, and muscle. Results: Overall 74 FDG positive lesions were visualized by both PET/CT and PET/MRI. No significant differences in anatomic allocation scores were found between PET/CT and PERT/MRI, while contrast score of lesions on PET/MRI was significantly higher. Both SUVmax and SUVmean of lesions were significantly higher on PET/MRI than on PET/CT, with strong correlations between PET/MRI and PET/CT data (ρ =0.71–0.88). MTVs of all lesions were 4% lower on PET/MRI than on PET/CT, but no statistically significant difference was observed, and an excellent correlation between measurements of MTV with PET/MRI and PET/CT was found (ρ =0.95–0.97; p <0.0001). Both SUVmax and SUVmean were significantly lower by PET/MRI than by PET/CT for lung, liver and muscle, no significant difference was observed for spleen, while either SUVmax and SUVmean of myocardium were significantly higher by PET/MRI. High correlations were found between PET/MRI and PET/CT for both SUVmax and SUVmean of the left ventricular myocardium (ρ =0.91; p <0.0001), while moderate correlations were found for the other normal organ tissues (ρ =0.36–0.61; p <0.05). Conclusions: PET/MRI showed equivalent performance in terms of qualitative lesion detection to PET/CT. Despite significant differences in tracer uptake quantification, due to either methodological and biological factors, PET/MRI and PET/CT measurements in lesions and normal organ tissues correlated well. This study demonstrates that integrated whole-body PET/MRI is feasible in a clinical setting with high quality and in a short examination time. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose of this study was to categorize the morphologic and kinetic features of enhancing lesions in breasts with interstitial mammoplasty using dynamic contrast-enhanced magnetic resonance imaging and to assess factors predictive of breast cancer. Materials and methods: We retrospectively reviewed the clinical and radiological data of 21 enhancing lesions in 19 patients with interstitial mammoplasty, who underwent breast magnetic resonance imaging and biopsy or an operation in our hospital from September 2008 to July 2012. These lesions were sorted by morphological and kinetic features and final assessment category according to the BI-RADS lexicon. Results: Nine cases were confirmed to be ductal carcinoma in situ (n =2) and invasive ductal carcinoma (n =7), and the remaining 12 cases were fibrocystic disease (n =2), fibroadenoma (n =2), fat necrosis (n =1), foreign body granuloma (n =3) and silicone mastitis (n =1). Common features of malignancy included irregular shape (50.0%), spiculated margins (75.0%), heterogeneous enhancement (50.0%) and type III kinetic pattern (87.5%). The correlations of margins and kinetic curve pattern with benignity and malignancy approached statistical significance (p =0.02, respectively). We found no correlation for shape (p =0.33) or internal enhancement (p =0.42) between lesion types. The malignancy rate of enhancing lesions was 42.8% (9/21). The sensitivity and specificity of dynamic contrast-enhanced magnetic resonance imaging were 100% and 16.67%, respectively. The positive predictive value, negative predictive value and accuracy of magnetic resonance imaging were 47.38%, 100% and 52.38%. Overall inter-observer agreement for the kinetic curve pattern was good (κ =0.67). Moderate agreement was seen in describing the shape, margin, enhancement and assessing the final category (κ =0.59, 0.46, 0.58 and 0.49, respectively). Conclusion: Dynamic contrast-enhanced magnetic resonance imaging had a high sensitivity, negative predictive value for the prediction of breast cancer but a low specificity due to features of foreign body-related lesions that mimicked malignant lesions. The significant predictive factors for malignancy were margins, kinetic curve pattern and final assessment category. Overall inter-observer agreement for the kinetic curve pattern was good. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to evaluate the capability of dynamic contrast enhanced MR-mammography (MRM) for the interpretation of axillary lymph nodes (LNs) in patients with breast cancer. Material and methods: 25 patients with breast cancer preoperatively underwent both FDG positron emission computed tomography (PET-CT) and dynamic contrast enhanced MRM. The maximum signal increase (SImax) and curve shape (types I–III) of contrast enhanced LNs ≥0.5cm (short-axis) were analyzed in MRM and correlated to the maximum standard uptake value (SUVmax) of FDG PET-CT. 29 healthy women with MRM served as control group. Enhancement kinetics of all malignant LNs were compared to LN findings of the healthy control group. Results: Overall 33 contrast enhanced LNs on preoperative MRM had a corresponding FDG uptake on PET-CT. 30 of the PET positive LNs were classified as surely malignant (mean SUVmax 7.3 (±5.4)). The mean SImax of these LNs was not significantly different to the control group (222% vs 197%), but malignant LNs had a significantly higher rate of type III curves with rapid washout (93% vs 66%, p =0.008). Conclusion: The maximum signal increase is not capable of differentiating malignant from benign axillary LNs. However, since malignant LNs showed a higher frequency of rapid washout curves (type III curves) on corresponding MRM future studies should concentrate on the analysis of this parameter. In clinical routine the curve shape still should be taken with care as there is a high overlap with benign LNs. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of the study was to evaluate the sensitivity of breast MRI in the detection of pure DCIS and to analyze the influence of lesion type and nuclear grade. Methods: 58 consecutive patients with pathologically proven pure DCIS and preoperatively performed breast MRI were retrospectively reviewed and analyzed. Sensitivities in the detection of DCIS were calculated for MRI and mammography (Mx). Influence of MRI lesion type and nuclear grading on DCIS diagnosis was evaluated. Results: MRI detected pure DCIS with a sensitivity of 79.3%. The sensitivity of Mx was lower (69%), but the difference was not statistically significant (p =0.345). 46.2% of the DCIS presented as enhancing mass and 53.8% as non-mass-like enhancement (NMLE). None of the masses but 21.4% (n =6) of the NMLE were underestimated as probably benign (BI-RADS® 3). MRI measured lesion sizes showed a moderate correlation (r =0.74) with histopathologically measured lesion sizes. MRI detection rate of DCIS decreased significantly (p =0.0458) with increasing nuclear grade. Calculated sensitivities were 100% for low-grade DCIS, 84.6% for intermediate-grade DCIS, and 66.7% for high-grade DCIS. Conclusions: In this study MRI could detect pure DCIS more sensitively than Mx. Despite of missing statistically significance preoperative MRI seems to be helpful in patients with DCIS who are eligible for breast conservation. This applies in particular to patients with non-high-grade DCIS because those were significantly more often positive on MRI and significantly more often negative on Mx. Misinterpretation occurs especially in cases of NMLE and high-grade DCIS and therefore a correlation with Mx is also recommended. [ABSTRACT FROM AUTHOR]