MRI In Women Research Articles

TOPICAL ISSUES OF DIAGNOSIS AND TREATMENT OF INFERTILITY IN WOMEN WITH INTERNAL GENITAL ENDOMETRIOSIS

The problem of infertility in women with internal genital endometriosis is one of the main reasons among the reasons for this infertility problem. The review presents modern literature data of recent years, in which endometriosis is considered as one of the main causes of infertility. Despite the existing methods of diagnosis and treatment of infertility associated with endometriosis, today there is no single algorithm for conducting such a category of patients. The need to define survey tactics is an important component in the effectiveness of treatment. When developing a plan for managing patients with infertility associated with endometriosis, the age of the woman, duration of infertility, the presence of pain and the stage of the disease should be taken into account. Treatment of infertility associated with endometriosis includes surgical methods, hormone treatment and the use of ART. According to some authors, the development of adenomyosis occurs during menstruation against the backdrop of regeneration, healing and re-epithelialization of the uterine mucosa. At this point, the introduction of endometrial cells into the “weakened” transition zone, which has structural and functional differences compared to the rest of the myometrium, can occur. The JZ “transition zone” is the region in the inner layer of the myometrium, which has received many definitions: an intermediate zone, an archiometry, an internal myometrium, a subendometric myometrium. This zone is a basal layer of myometrium and consists of longitudinally placed smooth muscle fibers, usually its thickness in women of reproductive age does not exceed 2–8 mm. Many researchers consider mechanical damage to the transition zone as the key pathogenetic link in adenomyosis. The main method of screening and the “gold standard” of primary instrumental diagnostics in gynecology remains transvaginal ultrasound examination of pelvic organs. Magnetic resonance imaging can also be used, the advantage of which in comparison with ultrasound is the possibility of obtaining an image in any plane and the absence of “invisible” zones, has a high resolution. A systematic review and meta-analysis of data obtained with transvaginal ultrasound and MRI in women with histologically confirmed adenomyosis showed a similarly high level of accuracy of diagnosis, but an important advantage of MRI was the standardization of images. However, not always with the deviations of the transitional zone of the uterus revealed with the help of MRI, histologically confirmed adenomyosis is subsequently diagnosed. There is a significant need to develop a common terminology and classification of violations of the transition zone of the myometrium, as well as systematization of ideas about instrumental criteria for diagnosis of adenomyosis.

Is pelvic MRI in women presenting with pelvic endometriosis suggestive of associated ileal, appendicular, or cecal involvement?

To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98-42.19), 5.8 (95% CI 1.12-30.07), and 6.74 (95% CI 1.23-36.77), respectively. Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.

Breast findings incidentally detected on body MRI.

ObjectivesTo evaluate breast findings incidentally detected on body MRI.MethodsA retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs).Results440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding.ConclusionsClinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.

Screening MRI in Women With a Personal History of Breast Cancer.

Screening MRI is recommended for individuals at high risk for breast cancer, based on genetic risk or family history (GFH); however, there is insufficient evidence to support screening MRI for women with a personal history (PH) of breast cancer. We compared screening MRI performance in women with PH vs GFH of breast cancer. We analyzed case-series registry data, collected at time of MRI and at 12-month follow-up, from our regional Clinical Oncology Data Integration project. MRI performance was compared in women with PH with those with GFH. Chi-square testing was used to identify associations between age, prior history of MRI, and clinical indication with MRI performance; logistic regression was used to determine the combined contribution of these variables in predicting risk of a false-positive exam. All statistical tests were two-sided. Of 1521 women who underwent screening MRI from July 2004 to November 2011, 915 had PH and 606 had GFH of breast cancer. Overall, MRI sensitivity was 79.4% for all cancers and 88.5% for invasive cancers. False-positive exams were lower in the PH vs GFH groups (12.3% vs 21.6%, P < .001), specificity was higher (94.0% vs 86.0%, P < .001), and sensitivity and cancer detection rate were not statistically different (P > .99). Age (P < .001), prior MRI (P < .001), and clinical indication (P < .001) were individually associated with initial false-positive rate; age and prior MRI remained statistically significant in multivariable modeling (P = .001 and P < .001, respectively). MRI performance is superior in women with PH compared with women with GFH. Screening MRI warrants consideration as an adjunct to mammography in women with a PH of breast cancer.

Intraoperative Monitoring and Evaluation of MRI in Women of Reproductive Age After Previously Performed Uterine Artery Embolization (UAE) and MRgFUS Ablation of Fibroids

Intraoperative Monitoring and Evaluation of MRI in Women of Reproductive Age After Previously Performed Uterine Artery Embolization (UAE) and MRgFUS Ablation of Fibroids

Abnormal Resting-State Connectivity at Functional MRI in Women with Premenstrual Syndrome

ObjectivesPremenstrual syndrome (PMS) refers to a series of cycling and relapsing physical, emotion and behavior syndromes that occur in the luteal phase and resolve soon after the onset of menses. Although PMS is widely recognized, its neural mechanism is still unclear.DesignTo address this question, we measured brain activity for women with PMS and women without PMS (control group) using resting-state functional magnetic resonance imaging (rs-fMRI). In addition, the participants should complete the emotion scales (Beck Anxiety Inventory, BAI; Beck Depression Inventory, BDI, before the scanning) as well as the stress perception scale (Visual analog scale for stress, VAS, before and after the scanning).ResultsThe results showed that compared with the control group, the PMS group had decreased connectivity in the middle frontal gyrus (MFG) and theparahippocampalgyrus (PHG), as well as increased connectivity in the left medial/superior temporal gyri (MTG/STG) and precentralgyrus within the default mode network (DMN); in addition, the PMS group had higher anxiety and depression scale scores, together with lower stress perception scores. Finally, there were significantly positive correlations between the stress perception scores and functional connectivity in the MFG and cuneus. The BDI scores in the PMS group were correlated negatively with the functional connectivity in the MFG and precuneus and correlated positively with the functional connectivity in the MTG.ConclusionThese findings suggest that compared with normal women, women with PMS displayed abnormal stress sensitivity, which was reflected in the decreased and increased functional connectivity within the DMN, blunted stress perception and higher depression.

Clinical symptoms related to anal sphincter defects and atrophy on external phased-array MR imaging.

Introduction and hypothesisDefecatory complaints have a severe impact on quality of life. The additional value of pelvic floor MRI in patients with defecatory complaints is unclear. Our aim was to correlate the presence of defects and atrophy of the anal sphincter complex using pelvic floor MRI in women with mixed pelvic floor symptoms and to establish patient characteristics and self reported complaints predictive of pathology.MethodsThis is a retrospective study among women with mixed pelvic floor symptoms who underwent external phased-array MRI and completed a questionnaire on bothersome defecatory complaints. Data on patient characteristics, including obstetrical history and questionnaire scores were correlated with the assessment of anal sphincter defects and atrophy on pelvic floor MRI.ResultsOne hundred and fifty-eight women were included. A defect of the external anal sphincter (EAS) and internal anal sphincter (IAS) was found in 18 (11 %) and 5 (3 %) patients respectively. Atrophy of the EAS was present in 72 patients (46 %), with more cases of mild (n = 52, 33 %) than severe atrophy (n = 20, 13 %). The variable “previous third or fourth degree tear” had a significant positive association with an IAS defect on MRI, with an OR of 9.533 (1.425–63.776). Patients with EAS atrophy had higher scores for fecal incontinence (indicating more bother) than patients without EAS atrophy. Higher age and BMI were true predictors of the presence of more severe EAS atrophy.ConclusionAtrophy of the EAS was highly prevalent in this population and was associated with bothersome symptoms of fecal incontinence.

Abstract P1-01-12: Preoperative breast MRI does not affect survival outcomes in T1-2 breast cancer patients who underwent breast-conserving therapy

Abstract Purpose: The aim of the study is to evaluate the efficacy of preoperative breast MRI in T1-2 women with breast cancer. Methods: Total 1179 patients, who had T1-2 breast cancer and underwent definitive surgery between 2007 and 2010, were reviewed in this study. Preoperative breast MRI was performed in 981 women with breast cancer. We divided patients into two groups: Patients underwent preoperative MRI and breast-conserving therapy (BCT), those who did not undergo preoperative MRI but BCT. Patients underwent preoperative MRI and total mastectomy were excluded. Clinicopathological features were analyzed using Chi-square or Fisher’s exact test if indicated. Survival analyses were examined using Kaplan-Meier method and log-rank test. Cox-proportional hazard model was accessed as multivariate analysis. Results: In 873 patients who underwent BCT, 675 patients (77.3%) received preoperative MRI, and 198 (22.7%) patients did not. Clinicopathological features including T-stage, Nodal status, histologic type, progesterone receptor, histologic grade, age group (≤ 35 vs. &amp;gt; 35 yr), adjuvant chemotherapy, radiation, and hormone therapy were not significantly different between two groups. Patients aged 50 or younger received more preoperative MRI than those over aged 50 years (42.8 % vs. 51.5%, p=0.02). Estrogen receptor positive-tumors were more common in patients with preoperative MRI (74.9% vs. 67.2%, p=0.03). HER2 over-expression was frequently found in women without preoperative MRI (7.9% vs. 14.6%, p&amp;lt;0.001). In univariate analyses, there was no significant difference in recurrence-free and overall survival between patients who underwent breast MRI and those who did not (p for RFS = 0.75, p for OS = 0.48). In multivariate analyses, preoperative MRI did not influence on RFS and OS (HR for RFS = 0.82, 95%CI= 0.35-1.91, HR for OS = 1.52, 95% CI= 0.40-5.76). Age group and HER2 were not associated with RFS and OS (all p&amp;gt;0.05). ER was an independent prognostic factor for RFS and OS (all p&amp;lt;0.01). Conclusions: Routine use of preoperative MRI in women with T1-2 breast cancer may not translate into better RFS and OS. Citation Format: Jegyu Ryu, Sanghwa Kim, Jee Ye Kim, Hyung Seok Park, Seho Park, Seung il Kim. Preoperative breast MRI does not affect survival outcomes in T1-2 breast cancer patients who underwent breast-conserving therapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-01-12.

Abstract P1-01-02: Mammographic breast density and magnetic resonance (MR) imaging in women with mammographically occult breast cancer

Abstract Background: Recent data suggests a correlation between mammographically-occult breast cancer (MOBC) and increasing breast density. There is a dearth of information on the assessment of the amount of fibroglandular tissue (FGT) with contiguous MR images through both breasts and background parenchymal enhancement (BPE) in women with MOBC. The purpose of this study was to evaluate the relationship between mammographic breast density (BD), BPE, and FGT in women with MOBC and mammographically evident breast cancer (MEBC). Methods: The Breast Cancer Database at our medical center was queried for all women who were newly diagnosed with breast cancer between 2010 and 2014. Variables included age, BD, BPE, FGT, tumor characteristics. Statistical analyses included Pearson’s Chi Square Tests. Results: Out of a total of 1781 women, there were 110 (6%) with MOBC and 1671 (94%) with MEBC. The median age of the cohort was 59 years. Majority of the patients had early stage disease (72%) and invasive ductal carcinoma (61%). There was a higher proportion of women with DCIS with MEBC (22%) compared to women with MOBC (16%) and a higher proportion of invasive lobular carcinoma in women with MOBC (17%) compared to the women with MEBC (10%). Increased mammographic BD was significantly associated with mammographically occult breast cancer (p&amp;lt;0.001). However, BPE (p=0.29) and FGT (p=0.28) were not associated with MOBC. In the MOBC group, there was a higher proportion of women with dense breasts on mammography (74%) compared to women with dense breasts on MRI (48%). Conclusions: For women who develop mammographically occult breast cancer, there are currently no guidelines regarding recommendations for future screening. Increased breast density reduces the sensitivity of mammography, which compromises the ability to detect meaningful findings. Our study shows that MRI may be less affected by obstacles of sensitivity that is usually associated with mammography. Our results support the use of MRI in women with dense breasts who are at higher risk of developing MOBC. By better understanding the patient population who are more likely to be diagnosed with mammographically-occult breast cancer, we can more effectively select patients who should be screened with breast MRI. Table 1. Mammographic breast density, BPE, and FGT in study populationVARIABLESTOTAL (N=1781)%MOBC (N=110)%MEBC (N=1671)%P-VALUESMAMMOGRAPHIC BREAST DENSITYPredominantly fatty94633916p&amp;lt;0.001Scattered fibroglandular58738252356240 Heterogeneously dense71547676164846 Extremely dense135914131219 BACKGROUND PARENCHYMAL ENHANCEMENTMinimal741615245915p=0.29Mild22549304819549 Moderate11625132110326 Marked4710584211 FIBROGLANDULAR TISSUEPredominantly fatty91217128423p=0.28Scattered fibroglandular16037244113637 Heterogeneously dense12128203410127 Extremely dense57138144913 Citation Format: Chun Jennifer, Freya Schnabel, Shira Schwartz, Jessica Billig, Jennifer Gillman, Linda Moy. Mammographic breast density and magnetic resonance (MR) imaging in women with mammographically occult breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-01-02.

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ.

MRI has been used increasingly in the diagnosis and management of women with invasive breast cancer. However, its usefulness in the preoperative assessment of ductal carcinoma in situ (DCIS) remains questionable. A meta-analysis was conducted to examine the effects of MRI on surgical treatment of DCIS by analysing studies comparing preoperative MRI with conventional preoperative assessment. Using random-effects modelling, the proportion of women with various outcomes in the MRI versus no-MRI groups was estimated, and the odds ratio (OR) and adjusted OR (adjusted for study-level median age) for each model were calculated. Nine eligible studies were identified that included 1077 women with DCIS who had preoperative MRI and 2175 who did not. MRI significantly increased the odds of having initial mastectomy (OR 1·72, P = 0·012; adjusted OR 1·76, P = 0·010). There were no significant differences in the proportion of women with positive margins following breast-conserving surgery (BCS) in the MRI and no-MRI groups (OR 0·80, P = 0·059; adjusted OR 1·10, P = 0·716), nor in the necessity of reoperation for positive margins after BCS (OR 1·06, P = 0·759; adjusted OR 1·04, P = 0·844). Overall mastectomy rates did not differ significantly according to whether or not MRI was performed (OR 1·23, P = 0·340; adjusted OR 0·97, P = 0·881). Preoperative MRI in women with DCIS is not associated with improvement in surgical outcomes.

Comprehensive breast MRI: an update

With increasing use of clinical breast MRI and a plethora of novel techniques and sequences for lesion characterisation, a standardised approach to lesion description and reporting is increasingly important. This facilitates meaningful research and audit, particularly in the context of multicentre studies. To this end the American College of Radiology has recently published the 5th edition of the BI-RADS lexicon, with revision of the MRI section including addition of new descriptors, modification of others and deletion of some that were rarely helpful in practice, such as ‘stippled’ enhancement [1]. Categories for fibroglandular volume are now a to d, in line with the descriptors for mammography, thus avoiding confusion with assessment category. The degree of background parenchymal enhancement is now purely descriptive, from none/minimal to marked. A new descriptor is clustered rim enhancement (usually indicating DCIS). Non mass-like enhancement becomes non mass enhancement, whereas ‘ductal’ enhancement becomes linear. Overall the effect is of simplification and consistency with the mammography and ultrasound lexicons. The lexicon highlights the importance of a structured report, including the indication, scan technique, salient findings and critically, an overall assessment with a clear recommendation for further management. This approach has been validated in a number of studies correlating the assessment category with histopathological findings and/or long-term follow-up [2,3]. Use of a standardised lexicon, modified in the light of available evidence, has obviated some of the interpretative challenges of breast MRI. Use of supplemental diffusion weighted imaging may also be helpful [4]. Nonetheless, technical and clinical challenges remain. Artefacts are problematic, especially at 3T [5], and medical physics support is essential for good quality diagnostic scans, especially at higher field strength. Most importantly, it should be remembered that to date, despite the recognised superiority of breast MRI over any other modality for breast cancer detection and local staging, there is no hard evidence for improved patient outcomes. Two randomised controlled trials and seven comparative cohort studies have not shown any benefit for preoperative MRI in terms of re-excision rates; rather, there is a trend to higher mastectomy rates [6]. No convincing beneficial effects have been demonstrated in terms of in-breast tumour recurrence rates, disease-free survival or overall survival. Regarding assessment of response to neoadjuvant chemotherapy, MRI correlates better than mammography or ultrasound with final pathology, but false positive and negative studies are frequent, with underestimation of the amount of residual disease in up to 30% and overestimation in around 20% of cases [7,8]. Though evidence is accruing that MRI may be helpful in early response assessment, this is by no means standardised and is heavily dependent on many factors, not least tumour immunophenotype. Finally, though screening breast MRI for women at high risk has approximately double the sensitivity of mammography with encouraging stage shift and high rates of node negativity, there is as yet no evidence of a reduction in breast cancer mortality [9,10]. This workshop will provide an update on the BI-RADS lexicon and indications for breast MRI, with expert tuition in hands-on analysis of case studies.

Is there a role for routine screening MRI in women with LCIS?

Women with lobular carcinoma in situ (LCIS) have an elevated breast cancer risk, yet the benefit of MRI screening is unclear. We examined cancer detection rates with mammography alone versus mammography plus MRI in this high-risk population. From a prospectively maintained, single-institution database, we identified 776 patients diagnosed with LCIS after the adoption of screening MRI in April 1999. In addition to annual mammography and breast exam, MRI was used at the discretion of the physician and patient. Kaplan-Meier methods and landmark analyses at 1, 2, and 3years following LCIS diagnosis were performed to compare rates of cancer detection with or without MRI. MRI screening was performed in 455 (59%) patients (median, 3/patient). Median time from LCIS diagnosis to first MRI was 9months (range 0.3-137months). Patients undergoing MRI were younger (p<0.0001), premenopausal (p<0.0001), and more likely to have≥1 first-degree relative with breast cancer (p=0.009). At a median follow-up of 58months, 98/776 (13%) patients developed cancer. The crude cancer detection rate in both screening groups was 13%. MRI was not associated with earlier stage, smaller size, or node negativity. Landmark analyses at 1, 2, and 3years after LCIS diagnosis failed to demonstrate increased cancer detection rates among women having MRI (p=0.23, 0.26, and 0.13, respectively). Although a diagnosis of LCIS remains a significant risk factor for breast cancer, the routine use of MRI does not result in increased cancer detection rates (short-term), nor does it result in earlier stage at diagnosis, illustrating the importance of defining optimal screening strategies for high-risk patients based on tumor biology rather than numerical risk.

Patient Age and Tumor Size Determine the Cancer Yield of Preoperative Bilateral Breast MRI in Women With Ductal Carcinoma In Situ

The objective of our study was to determine the cancer yield of preoperative breast MRI in women with newly diagnosed ductal carcinoma in situ (DCIS) and to identify subgroups of DCIS patients for whom MRI is more likely to identify additional cancers. A database search for patients with DCIS who had undergone breast surgery between 2007 and 2011 was performed. A total of 308 women (median age, 49 years; range, 25-82 years) with DCIS underwent mammography, sonography, and a preoperative evaluation with MRI. The cancer yield and positive biopsy rate were determined. Patient age at diagnosis, menopausal status, family history of breast cancer, mammographic breast density, index cancer size, nuclear grade, and estrogen receptor (ER) status were examined, and a multivariate logistic regression analysis was performed. The cancer yield was 8% (24/308), and the positive biopsy rate was 53% (24/45). Of the 24 additional cancers, 14 (58%) represented multifocal disease, two (8%) represented multicentric disease, and eight (33%) represented contralateral cancer. In a multivariate analysis, age and index cancer size were factors significantly associated with additional MRI-detected cancers. Compared with women≥50 years, women<50 years had a 3.2-fold higher frequency of detection (95% CI, 1.2-8.9; p=0.02). Compared with women with DCIS lesions smaller than 2.5 cm, women with DCIS lesions 2.5 cm or larger showed a 2.6-fold higher frequency of detection (95% CI, 1.1-6.3; p=0.04). Preoperative breast MRI can be considered in patients with DCIS who are <50 years old, have index cancers≥2.5 cm, or fulfill both criteria.

Magnetic resonance imaging: The evolution of breast imaging

Introduction and aimsTo provide an overview of the principle of current breast MRI, the available evidence concerning its indications and optimum use and future potentials. Methods and resultsTo date sensitivities of 90–91% have been achieved with a specificity of 72–75%. MRI is the most sensitive method for detecting invasive carcinoma and comparable to mammography concerning detection of DCIS. The achievable specificity, false positive and biopsy rates, however, are much lower than for screening mammography thus do not allow its use for screening of the general population. Indications with proven advantages concern screening of women at high risk and special diagnostic problems that cannot be solved by conventional imaging and percutaneous biopsy: search for primary tumour in CUP syndrome, differentiation of nipple retraction, differentiation of scarring versus recurrence and selected difficult cases. There is no proven benefit for its general use for preoperative staging. One major problem may concern the imperfect interface between imaging and surgery. Further research is also needed for the use of MRI in women at intermediate risk. In women at low risk MRI screening is not recommended. Novel possibilities of MRI concern diffusion weighted imaging as well as MR spectroscopy. Their value for improved lesion differentiation is not yet fully established. Their main potential appears to concern an improved and earlier prediction of response to neoadjuvant therapy. Future developments might address development of more specific contrast agents, replacement of vascular enhancing agents by special MR techniques, testing of sodium MRI or image fusion with other imaging modalities. Discussion/conclusionMRI allows new patho-physiological information and thus can complement the information available by conventional methods. Present research should concentrate on improving specificity, improving the interface of imaging and surgery and has to include outcome analyses. Due to issues of specificity the responsible use of MRI should be limited to appropriate indications.

Surgical impact of preoperative breast MRI in women below 40 years of age

Our aim was to evaluate the surgical impact of preoperative MRI in young patients. We reviewed a single-institution database of 283 consecutive patients below 40years of age and who were treated for breast cancer. Thirty-seven (13%) patients who received neoadjuvant chemotherapy were excluded. The remaining 246 patients included 124 (50%) who preoperatively underwent conventional imaging (CI), i.e., mammography/ultrasonography (CI-group), and 122 (50%) who underwent CI and dynamic MRI (CI+MRI-group). Pathology of surgical specimens served as a reference standard. Mann-Whitney, χ (2), and McNemar statistics were used. There were no significant differences between groups in terms of age, tumor pathologic subtype, stage, receptor, or nodal status. The mastectomy rate was 111/246 (45%) overall but was significantly different between groups (46/124, 37%, for the CI group and 65/122, 53%, for the CI+MRI group; p=0.011). Of 122 CI+MRI patients, 46 (38%) would have undergone mastectomy due to CI alone, while MRI determined 19 additional mastectomies, increasing the mastectomy rate from 38% to 53% (p<0.001). The number of patients with multifocal, multicentric, synchronous, or bilateral cancers was significantly different between groups (10/124, 8%, for the CI group and 33/122, 27%, for the CI+MRI group; p<0.001). In the CI+MRI group, multifocal, multicentric, or synchronous bilateral cancers were detected with mammography in 5/33 (15%) patients, with ultrasonography in 15/33 (45%) patients, and with MRI in 32/33 (97%) patients (p<0.005). Two mastectomies were due to false positives at both conventional tests in the CI group (2/124, 1.6%) and two mastectomies were due to MRI false positives in the CI+MRI group (2/122, 1.6%). In conclusion, breast cancer in young patients was treated with mastectomy in 37-38% of cases on the basis of CI only and in these patients MRI was more sensitive than CI for multifocal, multicentric, or synchronous bilateral cancers, resulting in an additional mastectomy rate of 15%. A low probability of inappropriate imaging-based decision-making for mastectomy exists for both CI alone and for CI+MRI, making presurgical needle biopsy mandatory for findings that suggest a need for mastectomy.

Classification of breast lesions pre‐contrast injection using water resonance lineshape analysis

Inhomogeneously broadened, non-Lorentzian water resonances have been observed in small image voxels of breast tissue. The non-Lorentzian components of the water resonance are probably produced by bulk magnetic susceptibility shifts caused by dense, deoxygenated tumor blood vessels (the 'blood oxygenation level-dependent' effect), but can also be produced by other characteristics of local anatomy and physiology, including calcifications and interfaces between different types of tissue. Here, we tested the hypothesis that the detection of non-Lorentzian components of the water resonance with high spectral and spatial resolution (HiSS) MRI allows the classification of breast lesions without the need to inject contrast agent. Eighteen malignant lesions and nine benign lesions were imaged with HiSS MRI at 1.5 T. A new algorithm was developed to detect non-Lorentzian (or off-peak) components of the water resonance. After a Lorentzian fit had been subtracted from the data, the largest peak in the residual spectrum in each voxel was identified as the major off-peak component of the water resonance. The difference in frequency between these off-peak components and the main water peaks, and their amplitudes, were measured in malignant lesions, benign lesions and breast fibroglandular tissue. Off-peak component frequencies were significantly different between malignant and benign lesions (p < 0.001). Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of HiSS off-peak component analysis compared with dynamic contrast-enhanced (DCE) MRI parameters. The areas under the ROC curves for the 'DCE rapid uptake fraction', 'DCE washout fraction', 'off-peak component amplitude' and 'off-peak component frequency' were 0.75, 0.83, 0.50 and 0.86, respectively. These results suggest that water resonance lineshape analysis performs well in the classification of breast lesions without contrast injection and could improve the diagnostic accuracy of clinical breast MR examinations. In addition, this approach may provide an alternative to DCE MRI in women who are at risk for adverse reactions to contrast media.

92. Cost-effectiveness of screening with additional MRI for women with familial risk for breast cancer without a genetic predisposition

92. Cost-effectiveness of screening with additional MRI for women with familial risk for breast cancer without a genetic predisposition

Circulation Editors' Picks

<i>Circulation</i> Editors' Picks

27 Cost-effectiveness of Screening with Additional MRI for Women with Familial Risk for Breast Cancer Without a Genetic Predisposition

27 Cost-effectiveness of Screening with Additional MRI for Women with Familial Risk for Breast Cancer Without a Genetic Predisposition

Comparison of the puborectal muscle on MRI in women with POP and levator ani defects with those with normal support and no defect

The objective of this study was to compare puborectal muscle integrity and bulk in women with both major levator ani (LA) defects on MRI and pelvic organ prolapse (POP) to women with normal LA muscle and normal support. This is a case-control study comparing 24 cases with known major LA defects and POP to 24 controls with normal LA and normal support. Axial T-2 weighted MRI scans of the pelvis were evaluated for integrity of the puborectal muscle and degree of muscle bulk. There were no significant group differences in age, body mass index, vaginal deliveries, or hysterectomy status. In all 48 subjects, the puborectal muscle was visible and had no disruption noted. There was no difference in muscle bulk between groups (control/case, thin 42% vs. 25%, average 42% vs. 38%, thick-17% vs. 38%; P = 0.47). Defects and loss of muscle bulk in the puborectal muscle are not seen on MRI in women with major LA defects and POP.