3 Tesla breast MR imaging as a problem-solving tool: Diagnostic performance and incidental lesions

PURPOSE

To investigate the diagnostic performance and incidental lesion yield of 3T breast MRI if used as a problem-solving tool.

METHODS

This retrospective, IRB-approved, cross-sectional, single-center study comprised 302 consecutive women (mean: 50±12 years; range: 20-79 years) who were undergoing 3T breast MRI between 03/2013-12/2014 for further workup of conventional and clinical breast findings. Images were read by experienced, board-certified radiologists. The reference standard was histopathology or follow-up ≥ two years. Sensitivity, specificity, PPV, and NPV were calculated. Results were stratified by conventional and clinical breast findings.

RESULTS

The reference standard revealed 53 true-positive, 243 true-negative, 20 false-positive, and two false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 96.4% (53/55), 92.4% (243/263), 72.6% (53/73), and 99.2% (243/245), respectively. In 5.3% (16/302) of all patients, incidental MRI lesions classified BI-RADS 3-5 were detected, 37.5% (6/16) of which were malignant. Breast composition and the imaging findings that had led to referral had no significant influence on the diagnostic performance of breast MR imaging (p>0.05).

CONCLUSION

3T breast MRI yields excellent diagnostic results if used as a problem-solving tool independent of referral reasons. The number of suspicious incidental lesions detected by MRI is low, but is associated with a substantial malignancy rate.

Breast MRI used as a problem-solving tool reliably excludes malignancy

PURPOSE

To evaluate the diagnostic performance of breast MRI if used as a problem-solving tool in BI-RADS 0 cases.

MATERIAL AND METHODS

In this IRB-approved, single-center study, 687 women underwent high-resolution-3D, dynamic contrast-enhanced breast magnetic resonance imaging (MRI) between January 2012 and December 2012. Of these, we analyzed 111 consecutive patients (mean age, 51 ± 12 years; range, 20-83 years) categorized as BI-RADS 0. Breast MRI findings were stratified by clinical presentations, conventional imaging findings, and breast density. MRI results were compared to the reference standard, defined as histopathology or an imaging follow-up of at least 1 year.

RESULTS

One hundred eleven patients with BI-RADS 0 conventional imaging findings revealed 30 (27%) mammographic masses, 57 (51.4%) mammographic architectural distortions, five (4.5%) mammographic microcalcifications, 17 (15.3%) ultrasound-only findings, and two palpable findings without imaging correlates. There were 15 true-positive, 85 true-negative, 11 false-positive, and zero false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 100% (15/15), 88.5% (85/96), 57.7% (15/26), and 100% (85/85), respectively. Breast density and reasons for referral had no significant influence on the diagnostic performance of breast MRI (p>0.05).

CONCLUSION

Breast MRI reliably excludes malignancy in conventional BI-RADS 0 cases resulting in a NPV of 100% (85/85) and a PPV of 57.7% (15/26).

Routine Use of Three-Dimensional Contrast-Enhanced Moving-Table MR Angiography in Patients with Peripheral Arterial Occlusive Disease: Comparison with Selective Digital Subtraction Angiography

PURPOSE

To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease.

METHODS

Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA.

RESULTS

Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, kappa = 0.9 +/- 0.03) and moderate stenosis (96.5% and 94.3%, kappa = 0.9 +/- 0.03).

CONCLUSION

Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.