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Update of Breast MR Imaging Architectural Interpretation Model¹

¹ From the Department of Radiologic Sciences, Hahnemann University Hospital, 246 N Broad St, MS 206, Philadelphia, PA 19102 (L.W.N.); and Department of Radiology, University of Pennsylvania Medical Center, Philadelphia (M.D.S., S.G.O.). From the 1999 RSNA scientific assembly. Received January 25, 2000; revision requested March 3; final revision received August 16; accepted September 19. L.W.N. supported in part by the Susan G. Komen Breast Cancer Foundation. M.D.S. supported in part by National Institutes of Health grants RO1-CA58358 and P41-RR02305 and General Electric Corporation. Address correspondence to L.W.N.

View larger version (43K): [in a new window]   Figure 1. Validated and expanded breast MR imaging interpretation model uses the total data set of 454 patients, including the original 192 patients. Individual nodes of the tree-shaped model detail the architectural features that define the node, the number of patients with cancer, the number of patients with benign abnormalities, the NPV, and the PPV. Benign terminal nodes are shaded. Figure 1 represents the model as we currently think it should be used. In the no lesion node, an NPV of 98% (90 of 92) and a PPV of 2% (two of 92) are thought to be more reflective of this feature because two of the cancers were studied by using a two-dimensional enhancement technique and were not located in the region of the breast chosen for dynamic enhancement. The other two cancers were small foci of predominately DCIS.

View larger version (56K): [in a new window]   Figure 2. Previously published terminal nodes that did not meet our validation criteria, as well as some of the expansion attempts that did not meet our expansion criteria, are illustrated. Figure 2 is included solely to show the data it contains and does not represent the model as we recommend it be used.

View larger version (136K): [in a new window]   Figure 3a. (a) Sagittal T2-weighted (5,000/120) and (b) sagittal contrast-enhanced fast multiplanar spoiled gradient-echo fat-saturated (9.3/2.2; flip angle, 35°) MR images show a smooth nonenhancing mass (arrow) in a 68-year-old woman with a mammographically visible mass that was colloid carcinoma. This case is a false-negative finding for the model terminal node smooth focal masses.

View larger version (182K): [in a new window]   Figure 3b. (a) Sagittal T2-weighted (5,000/120) and (b) sagittal contrast-enhanced fast multiplanar spoiled gradient-echo fat-saturated (9.3/2.2; flip angle, 35°) MR images show a smooth nonenhancing mass (arrow) in a 68-year-old woman with a mammographically visible mass that was colloid carcinoma. This case is a false-negative finding for the model terminal node smooth focal masses.

View larger version (151K): [in a new window]   Figure 4a. (a) Sagittal T2-weighted (5,000/114) and (b) sagittal contrast-enhanced fast multiplanar spoiled gradient-echo fat-saturated (27.9/3.6; flip angle, 30°) MR images show a lobulated mass (arrow) with nonenhancing internal septations in a 60-year-old woman with a mammographically visible mass that was an adenoid cystic carcinoma. This case is a false-negative finding for the model terminal node lobulated focal masses with nonenhancing internal septations.

View larger version (174K): [in a new window]   Figure 4b. (a) Sagittal T2-weighted (5,000/114) and (b) sagittal contrast-enhanced fast multiplanar spoiled gradient-echo fat-saturated (27.9/3.6; flip angle, 30°) MR images show a lobulated mass (arrow) with nonenhancing internal septations in a 60-year-old woman with a mammographically visible mass that was an adenoid cystic carcinoma. This case is a false-negative finding for the model terminal node lobulated focal masses with nonenhancing internal septations.

View larger version (125K): [in a new window]   Figure 5. Sagittal T2-weighted fat-saturated MR image (5,000/114) shows low T2 signal intensity in a lobulated mass (arrow) in a 42-year-old woman with a mammographically visible mass that was a fibroadenoma. This case is a true-negative finding for the model terminal node lobulated nonseptated enhancing focal masses with low T2 signal intensity.

View larger version (135K): [in a new window]   Figure 6. Sagittal T2-weighted fat-saturated MR image (5,000/120) shows low T2 signal intensity in a rim-enhancing irregular mass (arrow) in a 69-year-old woman with a mammographically visible mass that was invasive lobular carcinoma. This case is a true-positive finding for the model branch point irregular focal masses, in which masses are not categorized according to T2 signal intensity because low T2 signal intensity was not a reliable predictor of benignity in irregular or spiculated focal masses.

View larger version (145K): [in a new window]   Figure 7. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (20.9/2.4; flip angle, 45°) shows mild regional enhancement (arrow) without micronodularity (stippling) in a 49-year-old woman with a palpable mass that represented fibrocystic change. This case is a true-negative finding for the model branch point mild regional enhancement.

View larger version (140K): [in a new window]   Figure 8. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (9.2/2.2; flip angle, 90°) shows marked regional enhancement (arrows) without micronodularity (stippling) in a 28-year-old woman with a palpable mass that was angiosarcoma. This case is a true-positive finding for the model branch point moderate or marked regional enhancement.

View larger version (159K): [in a new window]   Figure 9. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (25.3/3.6; flip angle, 30°) shows linear ductal enhancement (arrow) in a 44-year-old woman with invasive ductal carcinoma and DCIS who presented with calcifications at mammography. This case is a true-positive finding for the model branch point ductal enhancement, which tended to represent malignancy, regardless of the morphology of the ductal enhancement.

View larger version (161K): [in a new window]   Figure 10. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (21/2.4; flip angle, 60°) shows branching ductal enhancement (arrow) in a 72-year-old woman with predominantly intraductal adenocarcinoma who presented with calcifications at mammography. This case is a true-positive finding for the model branch point ductal enhancement, which tended to represent malignancy, regardless of the morphology of the ductal enhancement.

View larger version (170K): [in a new window]   Figure 11. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (27.8/4.4; flip angle, 30°) shows micronodular (stippled) moderate regional enhancement (arrows) in a 46-year-old woman with a palpable mass that represented fibrocystic change. This case is a false-positive finding for the model branch point regional enhancement; micronodularity was not a reliable predictor of benign or malignant abnormality and thus was not added as a subdivision of regional enhancement.

View larger version (148K): [in a new window]   Figure 12. Sagittal contrast-enhanced fat-saturated fast multiplanar spoiled gradient-echo MR image (25.6/4.1; flip angle, 30°) shows micronodular (stippled) moderate regional enhancement (arrow) in a 44-year-old woman with calcifications that represented DCIS at mammography. This case is a true-positive finding for the model branch point regional enhancement; micronodularity was not a reliable predictor of benign or malignant abnormality and thus was not added as a subdivision of regional enhancement.