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Breast Carcinoma: Effect of Preoperative Contrast-enhanced MR Imaging on the Therapeutic Approach¹

¹ From the Department of Radiology, Georg-August University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. Received June 17, 1998; revision requested August 13; final revision received March 3, 1999; accepted July 1. Address reprint requests to U.F.

View larger version (11K): [in a new window]   Figure 1. Graph indicates the number of patients with 171 clinically occult lesions of the breast detected with different diagnostic modalities and combinations of diagnostic modalities. 1 = seen with US alone; 2 = seen with mammography alone; 3 = seen with MR imaging alone; 4 = seen with US and MR imaging alone; 5 = seen with mammography and MR imaging alone; 6 = seen with US, mammography, and MR imaging.

View larger version (135K): [in a new window]   Figure 2a. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.

View larger version (72K): [in a new window]   Figure 2b. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.

View larger version (135K): [in a new window]   Figure 2c. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.

View larger version (141K): [in a new window]   Figure 2d. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.

View larger version (141K): [in a new window]   Figure 2e. Images obtained in a 54-year-old-woman with synchronous, bilateral carcinoma of the breast. (a) Conventional craniocaudal mammograms show two neighboring masses (arrow) with partially ill-defined and partially spiculated margins in the medial part of the left breast (BI-RADS category 5). (b) Transverse maximum intensity projection, subtraction, contrast-enhanced, T1-weighted, FLASH MR image (336/5, 90° flip angle) of the breasts shows hypervascular lesions (large arrow) in the left breast that correspond to the mammographic findings. In addition, a small hypervascularized lesion (small arrow) is detectable in the central part of the right breast. This lesion was not visible with conventional mammography or US. MR-guided preoperative hook wire localization of the suspicious lesion seen with MR imaging alone in the right breast was performed 5 days after b was obtained. (c) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained with the patient in the supine position and with a stereotactic unit placed on the right breast before the administration of contrast material shows hypointense parenchyma (arrows) in the central part of the right breast. (d) Transverse, T1-weighted, two-dimensional, FLASH MR image (336/5, 90° flip angle) obtained 2 minutes after the intravenous administration of gadopentetate dimeglumine demonstrates the hypervascular lesion (arrow) within the parenchyma. (e) Transverse, T1-weighted, two-dimensional, spin-echo MR image (100/5, 90° flip angle) obtained after the insertion of a nonmagnetic hook wire demonstrates the correct position of the wire tip (arrow) within the lesion. Histopathologic analysis revealed a multifocal invasive ductal carcinoma (pT2) of the left breast and a 7-mm invasive ductal carcinoma (pT1) of the right breast.