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Total-Body Echo-planar MR Imaging in the Staging of Breast Cancer: Comparison with Conventional Methods—Early Experience¹

¹ From the Departments of Diagnostic Radiology (L.J.H., S.M., K.M.J.) and Internal Medicine (B.A.B.), Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510. From the 1996 RSNA scientific assembly. Received March 16, 1998; revision requested May 12; revision received August 4; accepted October 13. Address reprint requests to L.J.H.

View larger version (163K): [in a new window]   Figure 1. Patient 17. Total-body echo-planar T2-weighted spin-echo MR images (2,000/60) demonstrate widespread metastatic disease, which was confirmed with biopsy of the left side of the pleura. Selected nonenhanced axial images show metastases involving the A, left calvaria (arrow), B, right humerus (arrow) and left internal mammary lymph node (arrowhead), B and C, left and right pleural spaces (open arrows), D, thoracic vertebra (arrow), E, sacrum (solid arrows) and iliac bones (open arrows), F, left femur (arrow), and G, right femur (arrow).

View larger version (81K): [in a new window]   Figure 2. Patient 9. Presumed liver metastases. A and B, Nonenhanced axial total-body echo-planar inversion-recovery MR images (2,000/60/140) demonstrate metastases involving A, the posterior segment of the right hepatic lobe (arrow) and B, the right hepatic tip (arrow). C and D, Low-attenuation areas on contrast-enhanced abdominal contiguous axial CT scans were attributed to C, artifact (arrow) and D, volume averaging (arrow). Biopsy was not performed because of known skeletal metastases. Follow-up imaging after five cycles of doxorubicin hydrochloride demonstrated complete resolution of the liver metastases and partial resolution of the skeletal metastases.

View larger version (184K): [in a new window]   Figure 3. Patient 6. Skeletal metastases. A, Posterior-view bone scintigraphic scan shows uptake (arrows) in the cervical and thoracic spine, which was attributed to degenerative disease. B–E, Nonenhanced axial total-body echo-planar T2-weighted spin-echo MR images (2,000/60) demonstrate metastases involving B, the left humerus (arrow), C, midthoracic vertebral bodies (arrow), D, lower thoracic vertebral bodies (arrow), and E, vertebral pedicles (arrows). F, Conventional sagittal nonenhanced fast spin-echo inversion-recovery MR image (4,000/64/110) of the left humerus and G, conventional sagittal nonenhanced T1-weighted spin-echo MR image (467/12) of the thoracic spine confirm multiple metastatic lesions (arrow in F, arrows in G).

View larger version (118K): [in a new window]   Figure 4a. Patient 12. Liver metastases. (a, b) Nonenhanced axial total-body echo-planar T2-weighted spin-echo MR images (2,000/60) obtained at different levels demonstrate multiple liver metastases (arrows), which were confirmed with liver biopsy results. Conventional preoperative bone scintigraphic scans and chest radiographs were unremarkable.

View larger version (128K): [in a new window]   Figure 4b. Patient 12. Liver metastases. (a, b) Nonenhanced axial total-body echo-planar T2-weighted spin-echo MR images (2,000/60) obtained at different levels demonstrate multiple liver metastases (arrows), which were confirmed with liver biopsy results. Conventional preoperative bone scintigraphic scans and chest radiographs were unremarkable.