Breast MRI (eBook)

Contents 11
Foreword I --- Larry Norton, MD 6
Foreword II --- by Beryl McCormick, Clifford Hudis, and Patrick I. Borgen 7
Preface 9
Contributors 14
I Principles and Practice 16
1 Breast Magnetic Resonance Imaging: Historical Overview --- Joo Young Melissa Lee and Elizabeth A. Morris 17
1. Dynamic Approach 17
2. Time Intensity Curves 17
3. Morphologic Approach 18
4. Combination of Dynamic and Morphologic Approaches 19
5. Conclusion 19
References 19
2 Breast Magnetic Resonance Imaging Techniques --- Nola M. Hylton 21
1. MRI Versus Mammography 21
2. Technical Requirements for Performing Breast MRI 22
3. Imaging Coils 23
4. Patient Preparation and positioning 23
5. Image Acquisition Methods 23
6. Fat Suppression 26
7. Image Postprocessing 26
3 Setting Up a Breast Magnetic Resonance Imaging Program --- Elizabeth A. Morris 29
1. Patient Issues 29
2. Personnel Issues 30
3. Breast MRI Protocols 30
4. Scheduling Considerations 31
5. Patient Preparation 31
6. Examination Interpretation 33
7. Kinetic Analysis 33
8. Communication of Results 34
9. Interventional Issues 34
10. Data Gathering 34
11. Practice Growth Issues 34
12. Coil Issues 35
13. Selecting the Sequence 35
14. Memorial Sloan-Kettering Cancer Center Sequence 35
15. Conclusion 36
4 The Normal Breast --- Elizabeth A. Morris 37
1. Breast Anatomy 37
2. Vessels 43
3. Lymphatics and Lymph Nodes 45
4. Pectoralis Major Muscle 48
5. Breast Density 49
6. Premenopausal Breast 50
7. Postmenopausal Breast 52
8. Chemopreventive Agents 53
9. Pregnancy 53
10. Skin and Nipple 53
11. Fat 57
12. Fibrous Tissue and Calcifications 57
13. Conclusion 57
5 The Axilla --- Joo Young Melissa Lee and D. David Dershaw 59
1. Anatomy 59
2. Pathophysiology of Metastatic Disease to Lymph Nodes 59
3. Imaging Methods 60
4. Magnetic Resonance Imaging of Lymph Nodes 60
5. Identifying Metastatic Disease 61
6. New Contrast Agents 64
7. Conclusion 64
6 Breast Magnetic Resonance Imaging Lexicon --- Elizabeth A. Morris 65
1. Standardization of Terminology 65
2. Technique 66
3. Breast Histopathology and Magnetic Resonance Imaging 67
4. Morphologic Features 67
5. Description of Terms 67
6. Value of T2 91
7. Kinetics 91
8. Suggested Algorithm for Interpretation 91
7 Dynamic Breast Magnetic Resonance Imaging --- Christiane K. Kuhl 93
1. Pathophysiological Basis of Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging 93
2. Technical Issues 94
3. Choice of Pulse Sequences 95
4. Generating the Source Data for Kinetic Analysis: Region of Interest Placement 100
5. Analysis of Enhancement Kinetics 102
6. Pharmakokinetic Modeling 103
7. Understanding Published Literature:Survivors and One-Hit Wonders of Kinetic Approaches 103
8. How To Use Information Obtainedfrom Dynamic Data 105
9. Lesion Categorization: How We Integrate Morphologic and Kinetic Information 113
10. Appearance of the Normal and the Diseased Breast in Dynamic Contrast-enhanced Breast Magnetic Resonance Imaging 116
11. Current Applications of Dynamic Bilateral Breast Magnetic Resonance Imaging 142
12. Future Directions 149
8 Benign Lesions --- Andrea F. Abramson 154
1. Mass Lesions 154
2. Nonmass Lesions 171
3. High-Risk Lesions 176
9 Ductal Carcinoma In Situ --- Jennifer H. Menell 178
1. Mammography and Ductal Carcinoma In Situ 178
2. Magnetic Resonance Imaging and Ductal Carcinoma In Situ 179
3. Magnetic Resonance Imaging of Mammographically Evident Calcifications 179
4. False-Negative Results by Magnetic Resonance and Mammography 180
5. Nuclear Grade 180
6. Significant Ductal CarcinomaIn Situ Lesions on Magnetic Resonance Imaging 180
7. Conclusion 184
10 Magnetic Resonance Imaging of Invasive Breast Carcinoma --- Lia Bartella and D. David Dershaw 187
1. Tumor Neovascularity and Angiogenesis 187
2. Secondary Signs of Invasive Breast Cancer 188
3. Types of Invasive Breast Cancer 188
4. Invasive Ductal Carcinoma Not Otherwise Specified (NOS) 188
5. Specialized Subtypes of Invasive Ductal Carcinoma 189
6. Invasive Lobular Carcinoma 191
7. Other Breast Malignancies 192
8. Ductal Carcinoma In Situ Versus Invasive Carcinoma 195
11 The High-Risk Patient and Magnetic Resonance Imaging --- Laura Liberman 198
1. Models for Predicting Breast Cancer Risk 198
2. Screening Mammography:Guidelines and Limitations 198
3. Breast Magnetic Resonance Imaging Screening: Published Results 199
4. Ductal Carcinoma In Situ 204
5. False-positive Results 204
6. False-negative Results 207
7. Probably Benign Lesions at High-risk Screening Magnetic Resonance Imaging 207
8. Ultrasound Versus Magnetic Resonance Imaging for High-risk Screening 208
9. Second Look Ultrasound 208
10. Breast MRI in Women with BRCA Mutations 210
11. Caveats 211
12. Conclusion 211
12 Assessment of Extent of Disease Using Magnetic Resonance Imaging --- Laura Liberman 214
1. Ipsilateral Breast 214
2. Contralateral Breast 221
3. Invasive Lobular Cancer 223
4. Conclusion 225
13 Assessment of Residual Disease --- Elizabeth A. Morris 228
1. The Preoperative Work-Up 228
2. Relationship Between Residual and Recurrent Disease 228
3. Pathology Issues 238
4. Postoperative Work–Up 238
5. Magnetic Resonance Imaging Experience 238
6. Goals of Breast Cancer Treatment 239
7. Treatment Issues 239
8. Conclusion 239
14 Posttherapeutic Magnetic Resonance Imaging --- Jennifer B. Kaplan and D. David Dershaw 241
1. Neoadjuvant Therapy 241
2. Magnetic Resonance Imaging and Breast Conservation Therapy 246
15 Magnetic Resonance Imaging in Women with Breast Implants --- Laura Liberman and Wendie A. Berg 252
1. Implants: Types and Terms 252
2. Implant Failure 253
3. Imaging Implant Rupture 254
4. Breast Cancer Detection in Women with Implants 266
5. Summary and Conclusions 268
16 Magnetic Resonance Imaging as a Clinical Tool --- D. David Dershaw 270
1. The Augmented Breast 270
2. Lesion Characterization 271
3. Breast Conservation: Staging Tumor and Detecting Recurrence 273
4. Assessing Treatment Response 275
5. Disease of the Nipple 276
6. Unknown Primary 276
7. Screening 278
17 Breast Magnetic Resonance Spectroscopy --- Robert E. Lenkinski and Rachel Katz-Brull 280
1. Magnetic Resonance Spectroscopy of the Breast 281
2. Nuclear Magnetic Resonance Studies of Human Tissues and Tissue Extracts 281
3. Phosphorus-31 Magnetic Resonance Spectroscopy Studies of Human Breast Disease 282
4. Clinical Single Voxel Proton Magnetic Resonance Spectroscopy of the Breast 282
5. Future Developments 283
6. Summary 285
18 The Surgeon’s Perspective --- Alexandra Heerdt 287
1. Screening for and Diagnosis of Breast Cancer 287
2. Local Therapy for Breast Cancer 288
3. Continuing Surveillance of the Breast Cancer Patient 290
4. Magnetic Resonance Imaging Guided Needle Localization: Technical Considerations for the Surgeon 290
19 Magnetic Resonance Imaging Guided Needle Localization --- Laura Liberman 294
1. Equipment Considerations 294
2. Breast Magnetic Resonance Imaging Technique and Interpretation at Memorial Sloan-Kettering Cancer Center 297
3. Magnetic Resonance Imaging Guided Localization Technique 298
4. Magnetic Resonance Imaging Guided Needle Localization: Memorial Sloan-Kettering Cancer Center Experience 303
5. Challenging Scenarios at Magnetic Resonance Imaging Guided Localization 305
6. Advice and Caveats 306
7. Conclusions 309
20 Percutaneous Magnetic Resonance Imaging Guided Breast Biopsy --- Laura Liberman 311
1. Fine Needle Aspiration Biopsy 311
2. Automated Core Biopsy 312
3. Vacuum-Assisted Biopsy 313
4. Challenging Scenarios at Magnetic Resonance Imaging Guided Vacuum-Assisted Biopsy 326
5. Conclusion 327
21 Image-Guided Ablation of Breast Cancer --- Laura Liberman and Nanette Bracero 330
1. Terminology 330
2. Methods of Thermal Destruction 331
3. Image-Guided Ablation of Breast Cancer: Problems 337
4. Summary and Conclusions 338
II Atlas 340
22 Normal Breast 341
1. Breast Density 341
2. Nipple 345
23 Malignant Lesions 346
1. Distribution of Tumor 346
2. Staging 366
3. Metastasis 384
4. Invasive Carcinoma 385
5. Ductal Carcinoma In Situ 397
6. Other Tumors 404
7. Recurrence 406
8. Residual 411
24 High-Risk Lesions 420
1. Atypical Duct Hyperplasia 420
2. Atypical Lobular Hyperplasia 422
3. Lobular Carcinoma In Situ 422
4. Radial Scar 425
25 Benign Lesions 426
1. Fibroadenoma 426
2. Cysts 434
3. Lymph Nodes 439
4. Duct Ectasia 449
5. Papilloma 452
6. Fibrocystic Changes 454
7. Abscess 460
8. Duct Hyperplasia 461
9. Sclerosing Adenosis 463
10. Adenomyoepithelioma 464
11. Fibrosis 464
12. Pseudoangiomatous Stromal Hyperplasia 467
13. Skin Lesions 471
14. Gynecomastia 474
26 Findings Following Intervention 475
1. Excisional Biopsy 475
2. Needle Biopsy 494
3. Reconstructive Surgery 496
27 Pitfalls in Analysis of Carcinomas 500
1. Atypical Appearance of Carcinomas 500
2. Suboptimal Positioning 507
3. Suboptimal Windowing 509
4. Coil Artifact 511
5. Metallic Artifact 512
6. Misregistration 513
Index 514