MRI of the Breast for Preoperative Evaluation in Patients With Localized Breast Cancer
Breast mri 10
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By
Women Women Imaging UnitImaging Unit
Kasr El Aini – Cairo Kasr El Aini – Cairo UniversityUniversity
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In certain situations, clinical examination, mammography and ultrasonography have some limitations; due to factors in the modality or breast parenchymaMR imaging has an important role in clinical practice; both in lesion characterization and tumor staging. (Khatri rt al, 2001)A major cost reduction can be achieved by prevention of unnecessary surgery, and additional trauma for the patient . (Schmitt et al, 2001)
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Sensitive to small abnormalitiesSensitive to small abnormalities..
Effective in dense breastsEffective in dense breasts..
Characterization of breast lesionsCharacterization of breast lesions..
Staging of malignant neoplasmStaging of malignant neoplasm..
Follow-up of patients after different lines of Follow-up of patients after different lines of treatmenttreatment
Can image breast implant/ruptureCan image breast implant/rupture..
Can locate occult primary tumor in women who Can locate occult primary tumor in women who present by malignant axillary lymph nodepresent by malignant axillary lymph node
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Cannot image calcifications, as tiny Cannot image calcifications, as tiny calcium deposit can indicate early calcium deposit can indicate early breast cancersbreast cancers..
Expensive and not widely availableExpensive and not widely available..
Some patients who are claustrophobic may not Some patients who are claustrophobic may not
tolerate MRItolerate MRI..
Requires use of contrast agentRequires use of contrast agent . .
More time-consuming than mammographyMore time-consuming than mammography . .
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Suspicious mammographic Suspicious mammographic findings of malignancy findings of malignancy
includeinclude::
Spiculated or stellate masses with or without micro-calcifications.
Asymmetrical breast tissue especially when associated with calcifications .
Areas of architectural distortion.
Pleomorpheic micro-calcifications that are greater than five in number.
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Patterns of normal parenchymal enhancement
1 No enhancement
2 Minimal or mild enhancement
3 small focal areas of slow or rapid enhancement
4 slow or rapid regional enhancement
5 slow or rapid patchy enhancement
6 Diffuse slow enhancement
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.T2WI Fat suppressedT2WI Fat suppressed T1WIT1WI
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Qualitative methodsQualitative methods Quantitative methodsQuantitative methods Qualitative methodsQualitative methods
11 - -Early appearance of Early appearance of enhancementenhancement
22 - -Peripheral lesion enhancementPeripheral lesion enhancement
33 - -Border irregularityBorder irregularity
44 - -Enhancement inhomogeneityEnhancement inhomogeneity
55 - -converging vesselsconverging vessels
66 - -Signs of malignancy spreadSigns of malignancy spread
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Quantitative methodsQuantitative methods
11--Enhancement amplitude in Enhancement amplitude in the 1st two minthe 1st two min..
22--Early peak of enhancement Early peak of enhancement curvecurve
33 - -Early washoutEarly washout
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MalignantMalignant
BenignBenign
22 minmin..
77 minmin..
> >
6060%
%
< <6060
%
%
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3 minutes
110%
Bilateral breast
fibroadenomas
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7 minutes
70 %
Granulomatus mastitis
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7 minutes
25 %
Benign phylloids
tumor grade II
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4 minutes
70 %
Invasive Duct
Carcinoma grade II
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4 minutes
70 %Multifocal Invasive
Duct Carcinoma grade II
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3min.—105%4min.– 70%4min.– 70%
Inflammtory Carcinomatosi
s +
Invasive Duct Carcinoma
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3min.—105%7min.– 90%10min.– 90%
Multicentric Invasive Lobular
Carcinoma grade IV
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4 minutes
85 %
Paget’s Disease
of the Nipple
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3 minutes
35 %
Mucinous Adeno -
carcinoma
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7 minutes
82.5 %
Adenoid Cystic
Carcinoma
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Post contrast MRM can give relevant additional information in patients with mammographically dense breasts, or inhomogeneous tissue on sonography, or both.
Both qualitative and quantitative criteria are needed for lesion interpretation.
Preoperative post contrast breast MRI has the potential to reveal mammographically & sonographically hidden multifocal, multicenteric, or contralateral breast carcinoma
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Additional diagnostic studies
Breast US &/or DopplerBreast US &/or Doppler
ResultsResults
Normal Benign
Indeterminate/Suspicious
Possibly malignant
6-month follow-up Guided biopsy Surgical biopsy
.Suspicious Suspicious MammogramsMammograms
Microfocal spot magnification
Compression & oblique
images
Dynamic post-contrast MR mammography
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