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.

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

Dynamic contrast-enhanced MRI (DCE-MRI) is a functional MRI method where T1 -weighted MR images are acquired dynamically after bolus injection of a contrast agent.

The data can be interpreted in terms of physiological tissue characteristics by applying the principles of tracer-kinetic modelling. In the brain, DCE-MRI enables measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), blood–brain barrier (BBB) permeability–surface area product (PS) and the volume of the interstitium (ve). These parameters can be combined to form others such as the volume-transfer constant Ktrans, the extraction fraction E and the contrast-agent mean transit times through the intra- and extravascular spaces.

A first generation of tracer-kinetic models for DCE-MRI was developed in the early 1990s and has become a standard in many applications. Subsequent improvements in DCE-MRI data quality have driven the development of a second generation of more complex models. They are increasingly used, but it is not always clear how they relate to the models of the first generation or to the model-free deconvolution methods for tissues with intact BBB. This lack of understanding is leading to increasing confusion on when to use which model and how to interpret the parameters.

The purpose of this review is to clarify the relation between models of the first and second generations and between model-based and model-free methods. All quantities are defined using a generic terminology to ensure the widest possible scope and to reveal the link between applications in the brain and in other organs. Copyright © 2013 John Wiley & Sons, Ltd.

Classic models for dynamic contrast-enhanced MRI.

Dynamic Contrast-enhanced MRI Studies in Oncology with an Emphasis on Quantification, Validation and Human Studies

Application of CT in the investigation of angiogenesis in oncology.

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.

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