Dynamic Breast Magnetic Resonance Imaging in the Assessment of Breast Glandular Tissue in High Risk Patients after Prophylactic Ovariectomy.

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Abstract Purpose: To evaluate the enhancement of breast glandular tissue by dynamic magnetic resonance imaging (MRI) in high risk patients, before and after prophylactic ovariectomy.Materials and Methods: A retrospective study was performed on 28 patients with high risk for breast and ovarian cancer who underwent preventive bilateral ovariectomy. Seven patients who were at hormone replacement therapy and chemotherapy were excluded. From the 21 patients included, 12 were BRCA 1; 6 were BRCA 2; 1 was BRCA 1 – 2; and 2 patients had strong familiar history. All patients underwent contrast breast MRI before and after surgery, for breast cancer screening. MRI was performed at GE Healthcare 1.5 Tesla equipement before (mask) and after 5 phases of contrast injection. All pre contrast images were subtracted from the post contrast images. The second subtracted sequences of MRI images were analyzed qualitatively according to the type of glandular enhancement (1. no enhancement, 2. mild homogeneous, 3. strong heterogeneous, 4. strong homogeneous, 5. mild heterogeneous), and quantitatively by measuring signal intensity of glandular tissue in the upper outer quadrant of the breast in the second sequence of post-contrast images. Patients were divided into 2 groups: with and without the appearance of a lesion between the first and second MRI, for comparative analysis with the fibroglandular tissue.Results: Mean age was 44 years (39-51). In qualitative analysis at MRI before ovariectomy (MRI 1), 33% of the patients showed type 3 enhancement; 33% type 5; 29% type 4 and 5% type 1. At MRI post-ovariectomy (MRI 2), 67% of the patients presented enhancement type 1; 19% type 4 and 14% type 3. Twenty patients showed a higher enhancement at MRI 1 and for 1 patient the enhancement was the same at MRI 1 and 2. In quantitative analysis, the average of enhancement of the glandular tissue at MRI 1 was 356.1 and for MRI 2 was 65.2. Three patients presented an enhanced nodule on the first and second MRI. The average of enhancement of the lesions at MRI 1 was 890.9 and at MRI 2 was 452.9.Conclusion: Ovariectomy substantially reduces the physiological fibroglandular breast enhancement. The significant decrease of the glandular breast enhancement in MRI can help to detect organic focal breast lesion, such as atypical ductal hyperplasia and to differentiate it from functional foci. The comprehension of this changes can lead to decrease the number of false positives in breast MRI interpretation. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4024.