Purpose To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more). Patients and Methods We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared. Results Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasoun...

http://gulfimagingmri.com/PDFs/MammographyUltasoundMRIforHigh-RiskWomen.pdf

Mammography, Breast Ultrasound, and Magnetic Resonance Imaging for Surveillance of Women at High Familial Risk for Breast Cancer

Compared with mammography and breast ultrasonography, contrast material–enhanced magnetic resonance (MR) imaging is a breast imaging technique that offers not only information on lesion cross-sectional morphology but also on functional lesion features such as tissue perfusion and enhancement kinetics. After an enthusiastic start to clinical breast MR imaging in the early 1990s, a variety of difficulties and obstacles were identified that hampered the transfer of the modality into clinical practice, including a lack of standardization regarding image acquisition and interpretation guidelines, a lack of MR-compatible interventional materials, and a lack of evidence regarding its diagnostic accuracy—particularly specificity and positive predictive value, as well as sensitivity for ductal carcinoma in situ. This article is the first of two on the current status of breast MR imaging. The pathophysiologic basis of breast MR and the effects on acquisition technique and diagnostic accuracy, the diverging demands ...

The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice.

With the introduction of contrast agents, advances in surface coil technology, and development of new imaging protocols, contrast agent-enhanced magnetic resonance (MR) imaging has emerged as a promising modality for detection, diagnosis, and staging of breast cancer. The reported sensitivity of MR imaging for the visualization of invasive cancer has approached 100%. There are many examples in the literature of MR imaging--demonstrated mammographically, sonographically, and clinically occult breast cancer. Often, breast cancer detected on MR images has resulted in a change in patient care. Despite these results, there are many unresolved issues, including no defined standard technique for contrast-enhanced breast MR imaging, no standard interpretation criteria for evaluating such studies, no consensus on what constitutes clinically important enhancement, and no clearly defined clinical indications for the use of MR imaging. Furthermore, this technology remains costly, and issues of cost-effectiveness and cost competition from percutaneous biopsy have yet to be fully addressed. These factors along with the lack of commercially available MR imaging--guided localization and biopsy systems have slowed the transfer of this imaging technology from research centers to clinical breast imaging practices. Technical requirements, potential clinical applications, and potential pitfalls and limitations of contrast-enhanced MR imaging as a method to help detect, diagnose, and stage breast cancer will be described.

MR Imaging of the Breast for the Detection, Diagnosis, and Staging of Breast Cancer

System, method and apparatus for carrying out the recovery of an intact volume of tissue wherein a delivery cannula distal end is positioned in confronting adjacency with the volume of tissue to be recovered. An expandable metal capture component (116) is expressed from the distal end of the cannula (80) to expand while being electrically excited to electrosurgically cut around and circumscribe the tissue volume. Pursing cables (100, 101) are tensioned to complete the envelopment of the tissue volume, whereupon the volume is recovered by withdrawal of the instrument.

Minimally invasive intact recovery of tissue

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is performed after the administration of intravenous contrast medium to noninvasively access tumor vascular characteristics. DCE-MRI techniques utilizing low-molecular-weight contrast media have successfully made the transition from methodological development to preclinical and clinical validation and are now rapidly becoming mainstream clinical tools. DCE-MRI using macromolecular contrast medium (MMCM) can also assay microvascular characteristics of human tumor xenografts. MMCM approval for human use will occur soon. The success of both techniques depends on their ability to demonstrate quantitative differences of contrast medium behavior in a variety of tissues. Evidence is mounting that kinetic parameters correlate with immunohistochemical surrogates of tumor angiogenesis, including microvessel density, and with pathologic tumor grade. DCE-MRI is being applied to monitor the clinical effectiveness of a variety of treatments, including antiangiogenic drugs. Kinetic parameter changes following treatment have correlated with histopathological outcome and patient survival. This article reviews the current clinical status of low-molecular-weight DCE-MRI and reviews the potential of MMCM techniques for evaluating human tumors. Ongoing challenges faced by DCE-MRI as clinical and research tools will be explored.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.10176

Dynamic contrast‐enhanced MRI in clinical oncology: Current status and future directions

PURPOSE: To evaluate the differentiation of benign from malignant breast tumors with T2*-weighted perfusion magnetic resonance (MR) imaging (blood volume imaging) versus that with dynamic T1-weighted contrast agent-enhanced MR imaging. MATERIALS AND METHODS: Ten healthy adult volunteers and 18 adult patients with benign or malignant lesions underwent both conventional T1-weighted dynamic contrast-enhanced breast MR imaging and repetitive first-pass, single-section, dynamic T2*-weighted perfusion MR imaging. Images were obtained before, during, and after injection of 20 mL of gadopentetate dimeglumine; peak gadopentetate dimeglumine concentrations were calculated from the maximal signal intensity loss on T2*-weighted images. RESULTS: No perfusion effect was detectable in healthy breast parenchyma. A strong susceptibility-mediated signal intensity loss occurred in malignant breast tumors. No or only minor perfusion effects were seen in fibroadenomas, in spite of their rapid enhancement at T1-weighted dynami...

Breast neoplasms: T2* susceptibility-contrast, first-pass perfusion MR imaging.

A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical data set in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.

/pdf/model-based-hepatic-percutaneous-microwave-ablation-planning-uhr1zlcu.pdf

Model-based hepatic percutaneous microwave ablation planning. First validation on a clinical dataset

PURPOSE: To evaluate the usefulness of preoperative magnetic resonance (MR) imaging-guided stereotactic localization and core biopsy of suspicious breast lesions that are visible at breast MR imaging alone (ie, that are clinically, mammographically, and ultrasonographically occult), with the goal of integrating this technique into the diagnostic and therapeutic work-up of MR-suspicious lesions in a clinical setting. MATERIALS AND METHODS: A stereotactic breast biopsy device was used for needle placement in and guide wire localization of 97 lesions in 66 patients or core biopsy of five lesions in five patients; all lesions were visible at MR imaging. Interventions were performed with MR guidance on a 0.5- or 1.5-T system. RESULTS: Lesion localization and resection were successful in 95 of the 97 lesions; two of the lesions were not resected in spite of correct guide wire localization. In this series, 53 (55%) of 97 lesions proved malignant (11 [21%] in situ; 42 [79%] invasive). Lesions were 4-19 mm (mean, 8.7 mm); all invasive cancers corresponded to a pT1 tumor stage. Location of the lesion in the parenchyma (retroareolar or prepectoral) did not interfere with accessibility. CONCLUSION: MR imaging-guided stereotactic hook-wire placement and excisional biopsy are accurate and effective in managing lesions identified at only breast MR imaging. MR imaging-guided core biopsy holds promise for allowing a definite work-up of these lesions.

Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device.

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Breast neoplasms: T2* susceptibility-contrast, first-pass perfusion MR imaging.

Model-based hepatic percutaneous microwave ablation planning. First validation on a clinical dataset

Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device.