Changes in magnetic resonance mammography due to hormone replacement therapy.

Stefan Or Pfleiderer,Ansgar Malich,Susanne Wurdinger,Werner A Kaiser,Christiane Marx,Steffen Sachse,Dieter Sauner

doi:10.1186/bcr779

Stefan Or Pfleiderer, Ansgar Malich + Show 5 more

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https://doi.org/10.1186/bcr779

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Abstract

BackgroundThe aim of the present article is to investigate effects of hormone replacement therapy (HRT) on contrast medium enhancement patterns in postmenopausal patients during magnetic resonance mammography (MRM).Materials and methodsTwo hundred and fifteen patients receiving hormonal medication were divided into four groups: 150 patients with 1 MRM during HRT (group A), 13 patients with 2 MRMs under HRT (group B), 30 patients with 1 MRM during HRT and 1 MRM after HRT withdrawal (group C), and 22 women with 1 MRM after HRT withdrawal (group D). Dynamic MRM was performed at 1.5 Tesla. Signal intensity changes were characterized by five time curves: minimal enhancement (type I), weak continuous enhancement (type II), strong continuous enhancement (type III), and a steep initial slope followed by a plateau phenomenon (type IV) or a washout effect (type V).ResultsOf all 193 patients under HRT (group A + group B + group C), 60 patients (31.1%) showed curve type I, 88 patients (45.6%) showed type II and 45 patients (23.3%) showed type III. There were significant differences to 52 patients after HRT withdrawal (group C + group D) (P < 0.0001), with 42 patients (80.8%) for curve type I, 8 patients (15.4%) for type II, and 2 patients (3.8%) for type III. In both MRM sessions in group B, 69% of the patients showed identical curve types without significant differences (P = 0.375). In group C, 28 of 30 patients (93%) dropped to lower curve types with significant differences in curve types during and after HRT (P < 0.0001).ConclusionThe majority of patients receiving postmenopausal HRT showed bilateral symmetrical, continuous enhancement without evidence of a plateau phenomenon or a washout effect due to HRT in MRM. Hormonal effects could be proven and were reproducible and reversible.

Highlights

Observational studies have shown that women receiving hormone replacement therapy (HRT) have a reduced risk for osteoporosis [1,2] by preventive slowing of the decrease of bone mineral density in postmenopausal women
A strong enhancement after the injection of contrast medium (CM) with a continuous increase between 60% and 80% is demonstrated by curve type III
The current study demonstrates bilateral, symmetrical, synchronous, and progressive CM enhancement in the breast in dynamic magnetic resonance mammography (MRM) according to the findings of the majority of the patients receiving HRT

Summary

Introduction

Observational studies have shown that women receiving hormone replacement therapy (HRT) have a reduced risk for osteoporosis [1,2] by preventive slowing of the decrease of bone mineral density in postmenopausal women. Grimes and Lobo recently reported an increased risk for cardiovascular disease and breast cancer in the Women’s Health Initiative trial of HRT [5]. The relation of HRT and the increased risk for breast cancer has been controversially discussed for several years [6,7]. Even the specificity of mammography seems to be reduced with postmenopausal HRT [11]. The aim of the present article is to investigate effects of hormone replacement therapy (HRT) on contrast medium enhancement patterns in postmenopausal patients during magnetic resonance mammography (MRM)

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