Role of Recent MR Imaging Modalities in Diagnosis of Problematic Breast Lesions

Abstract

Background: Breast imaging reporting and data system (BIRADS) III and IV lesions are considered indeterminate breast lesions and an imaging dilemma. Contrast enhanced MRI shows high sensitivity in detecting these lesions but with low specificity leading to unnecessary biopsy in some of them and high false positive rate. So there was a need for new imaging techniques to raise the specificity of MRI. One of these new imaging techniques is MRS which can improve breast cancer diagnosis especially in indeterminate breast lesions. IT is a noninvasive method that can be added to the DCE–MRI of the breast increasing only the time of examination but allow better characterization of lesions depending on their chemical composition. Objective: To assess the diagnostic value of recent MR imaging modalities in diagnosis of problematic breast lesions categorized by mammography or sonomammography as (BIRADS III and IV) and correlation of these findings with available histopathological findings, clinical data or follow up. Patients and Methods: Study was carried out in the Radiology Department of Al-Azhar University Hospitals. The work took place during the period between May 2017 and June 2018. A total of 35 patients, presented with breast lesions for characterization, were included in the study. Results: We found that MRS measurement increased the specificity of the breast MRI in characterizing different breast lesions especially when it is combined with conventional dynamic MRI. Conclusion: MRS is a noninvasive scan that can be added easily to standard breast MRI protocols as an adjuvant tool. Detection of choline peak using choline SNR can accurately differentiate benign from malignant breast lesions especially indeterminate breast lesions with high sensitivity and specificity especially by adding its results with the results of the standard DCE- MRI scan.