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Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine magnetic resonance imaging ( MRI) screening recommendations and the subsequent outcomes in women with increased risk for breast cancer evaluated by oncology subspecialists at an academic center. Patients evaluated between 1/1/2007 and 3/1/2011 under diagnosis codes for family history of breast or ovarian cancer, genetic syndromes, lobular carcinoma in situ or atypical hyperplasia were included. Patients with a history of breast cancer were excluded. Retrospective review of prospectively acquired demographics, lifetime risk of breast cancer, and screening recommendations were obtained from the medical record. Retrospective review of the results of prospectively interpreted breast imaging examinations and image-guided biopsies were analyzed. 282 women were included. The majority of patients were premenopausal with a median age of 43. Most (69%) were referred due to a family history of breast or ovarian cancers. MRI was recommended for 84% of patients based on a documented lifetime risk >20%. Most women referred for MRI screening (88%) were compliant with this recommendation. A total of 299 breast MRI examinations were performed in 146 patients. Biopsy was performed for 32 (11%) exams and 10 cancers were detected for a positive predictive value (PPV) of 31% (based on biopsy performed) and an overall per exam cancer yield of 3.3%. Three cancers were detected in patients who did not undergo screening MRI. The 13 cancers were Stage 0-II; all patients were without evidence of disease with a median follow-up of 22 months. In a cohort of women seen by breast subspecialty providers, screening breast MRI was recommended according to guidelines, and used primarily in premenopausal women with a family history or genetic predisposition to breast cancer. Adherence to MRI screening recommendations was high and cancer yield from breast MRI was similar to that in clinical trials. [ABSTRACT FROM AUTHOR]

The use of breast MRI at 3 tesla (T) has increased in use substantially in recent years. Potential benefits of moving to higher field strength MRI include improved morphologic and kinetic assessment of breast lesions through higher spatial and temporal resolution dynamic contrast-enhanced MR examinations. Furthermore, higher field strength holds promise for the development of superior advanced breast MRI techniques, such as diffusion weighted imaging and MR spectroscopy. To fully realize the benefits of moving to 3T, a thorough understanding of the technical and safety challenges of higher field strength imaging specific to breast MRI is paramount. Through the use of advanced coil technology, parallel imaging, dual-source parallel radiofrequency excitation, and image-based shimming techniques, many of these limiting technical factors can be overcome to achieve high quality breast MRI at 3T. J. Magn. Reson. Imaging 2013;37:778-790. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose: To compare breast MRI B(1) homogeneity at 3 Tesla (T) with and without dual-source parallel radiofrequency (RF) excitation.Materials and Methods: After institutional review board approval, we evaluated 14 consecutive breast MR examinations performed at 3T that included three-dimensional B(1) maps created separately with conventional single-source and dual-source parallel RF excitation techniques. We measured B(1) values (expressed as % of intended B(1) ) on each B(1) map at nipple level in multiple bilateral locations: anterior, lateral, central, medial, and posterior. Mean whole breast and location specific B(1) values were calculated and compared between right and left breasts using paired t-test.Results: Mean whole breast B(1) values differed significantly between right and left breasts with standard single-source RF excitation (difference L-R, Δ = 9.2%; P < 0.001) but not with dual-source parallel RF excitation (Δ = 2.3%; P = 0.085). Location specific B(1) values differed significantly between right and left on single-source in the lateral (P = 0.014), central (P = 0.0001), medial (P = 0.0013), and posterior (P < 0.0001) locations. Conversely, mean B(1) values differed significantly on dual-source parallel RF excitation for only the anterior (P = 0.030) and lateral (P = 0.0003) locations.Conclusion: B(1) homogeneity is improved with dual-source parallel RF excitation on 3T breast MRI when compared with standard single-source RF excitation technique. [ABSTRACT FROM AUTHOR]

Purpose: To compare breast MRI B1 homogeneity at 3 Tesla (T) with and without dual-source parallel radiofrequency (RF) excitation. Materials and Methods: After institutional review board approval, we evaluated 14 consecutive breast MR examinations performed at 3T that included three-dimensional B1 maps created separately with conventional single-source and dual-source parallel RF excitation techniques. We measured B1 values (expressed as % of intended B1) on each B1 map at nipple level in multiple bilateral locations: anterior, lateral, central, medial, and posterior. Mean whole breast and location specific B1 values were calculated and compared between right and left breasts using paired t-test. Results: Mean whole breast B1 values differed significantly between right and left breasts with standard single-source RF excitation (difference L-R, Δ = 9.2%; P < 0.001) but not with dual-source parallel RF excitation (Δ = 2.3%; P = 0.085). Location specific B1 values differed significantly between right and left on single-source in the lateral ( P = 0.014), central ( P = 0.0001), medial ( P = 0.0013), and posterior ( P < 0.0001) locations. Conversely, mean B1 values differed significantly on dual-source parallel RF excitation for only the anterior ( P = 0.030) and lateral ( P = 0.0003) locations. Conclusion: B1 homogeneity is improved with dual-source parallel RF excitation on 3T breast MRI when compared with standard single-source RF excitation technique. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Breast magnetic resonance imaging (MRI) is routinely used as a problem-solving tool, but its benefit for this indication remains unclear. The records of 3001 consecutive breast MR examinations between January 1, 2003 and June 6, 2007 were reviewed to identify all those performed for the clinical indication of problem solving. Details of clinical presentation, mammography and ultrasound (US) findings, follow-up recommendations, and pathology outcomes were recorded. Benign versus malignant outcomes were determined by biopsy or 12 months of follow-up imaging and linkage with the regional tumor registry. Problem solving was the clinical indication for 204 of 3001 (7%) of all examinations. Forty-two of 204 examinations (21%) had suspicious or highly suspicious MRI assessments with recommendation for biopsy and 62 of 204 (79%) examinations were assessed as negative, benign, or probably benign. Thirty-six biopsies were performed based on MRI findings and 14 cancers were diagnosed. Biopsy was indicated for 11 of 14 (79%) cancers based on suspicious mammographic or US findings identified prior to MRI. One incidental cancer was detected by MRI alone in a patient at high risk for breast cancer, and two cancers were detected in patients with suspicious nipple discharge and negative mammogram and US. A single false-negative MRI occurred in a patient whose evaluation for a palpable lump prompted biopsy. Problem-solving breast MRI rarely identifies otherwise occult cancer and can be falsely negative in patients with suspicious findings on mammogram and US. Until the benefits and risks of problem-solving MRI are clarified, it should be used judiciously. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for mammographically and clinically occult breast lesions. Materials and Methods: The study included 91 women with 118 breast lesions (91 benign, 12 ductal carcinoma in situ [DCIS], 15 invasive carcinoma) initially detected on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and assigned BI-RADS category 3, 4, or 5. DWI was acquired with b = 0 and 600 s/mm2. Lesion visibility was assessed on DWI. Apparent diffusion coefficient (ADC) values were compared between malignancies, benign lesions, and normal (no abnormal enhancement on DCE-MRI) breast tissue, and the diagnostic performance of DWI was assessed based on ADC thresholding. Results: Twenty-four of 27 (89%) malignant and 74/91 (81%) benign lesions were hyperintense on the b = 600 s/mm2 diffusion-weighted images. Both DCIS (1.33 ± 0.19 × 10−3 mm2/s) and invasive carcinomas (1.30 ± 0.27 × 10−3mm2/s) were lower in ADC than benign lesions (1.71 ± 0.43 × 10−3mm2/s; P < 0.001), and each lesion type was lower in ADC than normal tissue (1.90 ± 0.38 × 10−3mm2/s, P ≤ 0.001). Receiver operating curve (ROC) analysis showed an area under the curve (AUC) of 0.77, and sensitivity = 96%, specificity = 55%, positive predictive value (PPV) = 39%, and negative predictive value (NPV) = 98% for an ADC threshold of 1.60 × 10−3mm2/s. Conclusion: Many mammographically and clinically occult breast carcinomas were visibly hyperintense on diffusion-weighted images, and ADC enabled differentiation from benign lesions. Further studies evaluating DWI while blinded to DCE-MRI are necessary to assess the potential of DWI as a noncontrast breast screening technique. J. Magn. Reson. Imaging 2010;1:562-570. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether diffusion tensor imaging (DTI) measures of anisotropy in breast tumors are different from normal breast tissue and can improve the discrimination between benign and malignant lesions. Materials and Methods: The study included 81 women with 105 breast lesions (76 malignant, 29 benign). DTI was performed during breast MRI examinations, and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured for breast lesions and normal tissue in each subject. FA and ADC were compared between cancers, benign lesions, and normal tissue by univariate and multivariate analyses. Results: The FA of carcinomas (mean ± SD: 0.24 ± 0.07) was significantly lower than normal breast tissue in the same subjects (0.29 ± 0.07; P < 0.0001). Multiple logistic regression showed that FA and ADC were each independent discriminators of malignancy ( P < 0.0001), and that FA improved discrimination between cancer and normal tissue over ADC alone. However, there was no difference in FA between malignant and benign lesions ( P = 0.98). Conclusion: Diffusion anisotropy is significantly lower in breast cancers than normal tissue, which may reflect alterations in tissue organization. Our preliminary results suggest that FA adds incremental value over ADC alone for discriminating malignant from normal tissue but does not help with distinguishing benign from malignant lesions. J. Magn. Reson. Imaging 2010; 31: 339-347. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

To identify the Breast Imaging Reporting and Data System magnetic resonance imaging (MRI) enhancement characteristics of ductal carcinoma in situ (DCIS). A retrospective review of consecutive patients who underwent breast MRI for newly diagnosed breast carcinoma prior to surgery was conducted. This yielded 381 lesions in 361 patients with pathologic confirmation of either DCIS alone, invasive carcinoma alone, or mixed invasive and in-situ disease. Presence or absence of a MRI lesion at the site of the documented carcinoma was recorded, and for all identified MRI lesions the Breast Imaging Reporting and Data System morphology patterns were recorded. MRI features of the different malignancy types were compared utilizing Fisher’s exact tests; 64/381 (16.8%) lesions had DCIS, 101/381 (26.5%) had invasive carcinoma, and 216/381 (56.7%) had mixed invasive/in situ carcinoma. A MRI lesion corresponding to the known cancer was identified in 55/64 (85.9%) cases of DCIS, 98/101 (97.0%) cases of invasive carcinoma, and 212/216 (98.1%) cases of mixed invasive and in-situ carcinoma. For pure DCIS lesions, 38/64 (59.4%) exhibited nonmass-like enhancement (NMLE), 9/64 (14.1%) were masses, and 8/64 (12.5%) were a focus. For pure invasive carcinomas 79/101(78.2%) were masses, 16/101 (15.8%) were NMLE, and 3/101 (3.0%) were a focus. For mixed lesions 163/216 (75.5%) were masses, 44/216 (20.4%) demonstrated NMLE, and 5/216 (2.3%) were a focus. The most common NMLE patterns of pure DCIS were segmental distribution and clumped internal enhancement. Although there is overlap in the MRI morphology and enhancement pattern of in situ and invasive breast carcinoma, DCIS more frequently manifests as NMLE than does invasive carcinoma. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the cancer yield, frequency of use, and follow-up compliance of breast MR examinations assessed as 'probably benign.' Materials and Methods We retrospectively reviewed our MR database of 809 consecutive examinations between January 2003 and June 2004. We identified all examinations that ultimately received an MR breast imaging reporting and data system (BI-RADS) 3 assessment and recommendation for a short-interval follow-up MR with or without an antecedent targeted ultrasound. The clinical indication for breast MR, date of the follow-up examination, follow-up assessment, and any pathology findings through June 2005 were collected from clinical records and radiology and pathology reports. Frequency of BI-RADS 3 use, follow-up compliance, and cancer yield were calculated. Results A total of 160 out of 809 (20%) examinations comprise the study population. A total of 100 out of 160 (63%) women returned for the recommended follow-up MR, in which three out of 100 (3%) were upgraded to BI-RADS 4 with biopsy recommended. One patient underwent biopsy and the result was benign. A total of seven out of 160 (4%) underwent mastectomy in lieu of MR for known cancer elsewhere in the breast. One out of seven mastectomy specimens contained malignancy that corresponded to the probably benign finding, resulting in a cancer yield of one out of 160 (0.6%). Conclusion Our data suggest that follow-up MR is a valid alternative to biopsy for MR BI-RADS 3 lesions. J. Magn. Reson. Imaging 2007;26:950-955. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]