Abstract
PurposeTo obtain breast vascular map and to assess correlation between predominant feeding vessel and tumor location with a semi-automatic method compared to conventional radiologic reading.Methods148 malignant and 75 benign breast lesions were included. All patients underwent bilateral MR imaging. Written informed consent was obtained from the patients before MRI. The local ethics committee granted approval for this study. Semi-automatic breast vascular map and predominant vessel detection was performed on MRI, for each patient. Semi-automatic detection (depending on grey levels threshold manually chosen by radiologist) was compared with results of two expert radiologists; inter-observer variability and reliability of semi-automatic approach were assessed.ResultsAnatomic analysis of breast lesions revealed that 20% of patients had masses in internal half, 50% in external half and the 30% in subareolar/central area. As regards the 44 tumors in internal half, based on radiologic consensus, 40 demonstrated a predominant feeding vessel (61% were supplied by internal thoracic vessels, 14% by lateral thoracic vessels, 16% by both thoracic vessels and 9% had no predominant feeding vessel—p<0.01), based on semi-automatic detection, 38 tumors demonstrated a predominant feeding vessel (66% were supplied by internal thoracic vessels, 11% by lateral thoracic vessels, 9% by both thoracic vessels and 14% had no predominant feeding vessel—p<0.01). As regards the 111 tumors in external half, based on radiologic consensus, 91 demonstrated a predominant feeding vessel (25% were supplied by internal thoracic vessels, 39% by lateral thoracic vessels, 18% by both thoracic vessels and 18% had no predominant feeding vessel—p<0.01), based on semi-automatic detection, 94 demonstrated a predominant feeding vessel (27% were supplied by internal thoracic vessels, 45% by lateral thoracic vessels, 4% by both thoracic vessels and 24% had no predominant feeding vessel—p<0.01). An excellent agreement between two radiologic assessments (k = 0.81) and between radiologic consensus and semi-automatic assessment (k = 0.80) was found to identify origin of predominant feeding vessel. An excellent reliability for semi-automatic assessment (Cronbach's alpha = 0.96) was reported.ConclusionsPredominant feeding vessel location was correlated with breast lesion location: internal thoracic artery supplied the highest proportion of breasts with tumor in internal half and lateral thoracic artery supplied the highest proportion of breasts with lateral tumor.
Highlights
Magnetic resonance imaging (MRI) has become an important imaging modality in the breast cancer diagnostic work-up
As regards the 44 tumors in internal half, based on radiologic consensus, 40 demonstrated a predominant feeding vessel (61% were supplied by internal thoracic vessels, 14% by lateral thoracic vessels, 16% by both thoracic vessels and 9% had no predominant feeding vessel—p
Vascular Map Detection on Breast Contrast Enhanced MR Imaging tumors in external half, based on radiologic consensus, 91 demonstrated a predominant feeding vessel (25% were supplied by internal thoracic vessels, 39% by lateral thoracic vessels, 18% by both thoracic vessels and 18% had no predominant feeding vessel—p
Summary
Magnetic resonance imaging (MRI) has become an important imaging modality in the breast cancer diagnostic work-up. Breast Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) provides the study of breast vascular map by means of the enhancement of an injected paramagnetic contrast agent. Maximum intensity projections (MIPs) obtained from post-processing of subtraction images can reveal the presence of enhancing lesions and the angiographic vessel vascular map of the whole bilateral breast. Kul et al [7] showed that both ipsilateral increased vascularity (sensitivity and specificity of 62% and 79%, respectively) and the adjacent vessel sign (sensitivity and specificity of 74% and 89%, respectively) are associated with breast cancer in a significant percentage of patients. In 2005, Malich et al [10] defined the adjacent vessel as “a prominent vessel leading to the lesion, seen in subtraction images” and reported it as “a minor sign of malignancy” present in 63% of 268 malignant lesions and in 28% of 60 benign lesions. A predominant medial vascular supply, connected to the internal mammary vessels, was seen in 87% of medial tumors and 48% of lateral tumors
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