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MR Imaging–guided Large-Core (14-Gauge) Needle Biopsy of Small Lesions Visible at Breast MR Imaging Alone¹

¹ From the Department of Radiology (C.K.K., N.M., C.C.L., A.S., H.H.S.) and Institute of Pathology (E.W.), University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany. Received May 19, 2000; revision requested July 12; final revision received January 5, 2001; accepted February 6. Address correspondence to C.K.K. (e-mail: kuhl@uni-bonn.de).

View larger version (98K): [in a new window]   Figure 1a. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (104K): [in a new window]   Figure 1b. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (135K): [in a new window]   Figure 1c. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (116K): [in a new window]   Figure 1d. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (100K): [in a new window]   Figure 1e. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (88K): [in a new window]   Figure 1f. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (93K): [in a new window]   Figure 1g. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (134K): [in a new window]   Figure 1h. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (100K): [in a new window]   Figure 1i. MR imaging-guided 14-gauge core biopsy of the right breast in a 48-year-old patient; an 8-mm equivocal lesion had been detected at diagnostic breast MR imaging (diagnostic image not shown). Histologic examination of the core biopsy specimen revealed myxoid fibroadenoma. Follow-up was 18 months. (a) Transverse precontrast T1-weighted gradient-echo MR image (280/4.6; flip angle, 90°). Arrowheads = fiducial system of stereotactic unit. (b) Transverse T1-weighted MR image (280/4.6) acquired after injection of 12 mL gadopentetate dimeglumine with the same parameters as in a shows the small well-circumscribed lesion (arrowheads) as having strong enhancement. (c) Transverse postcontrast subtraction image (b - a) shows the lesion as having high contrast. (d) Corresponding transverse T2-weighted turbo SE image (3,000/120) shows the lesion (arrowheads) with high signal intensity against the surrounding low-signal-intensity parenchyma. (e) Transverse postcontrast T1-weighted turbo SE image (350/10) obtained after attempted introduction of a 14-gauge core biopsy needle system shows the subcutaneous tissue (arrowheads) as displaced by the needle and shows that the target lesion itself is not visible (vanishing target). (f) Transverse T2-weighted turbo SE image (3,000/120) corresponding to e shows that the target lesion is still visible as a roundish hyperintense mass (arrowheads), as compared with the lesion in d. This suggests that the target position did not change despite the tissue shift at the needle insertion site. (g) Transverse T1-weighted turbo SE image (350/10) obtained after needle reinsertion and biopsy notch advancement through the calculated position of the target lesion (arrowheads) shows that the lesion itself is not visible owing to the vanishing target phenomenon. (h) Transverse subtraction T1-weighted turbo SE image with the same needle position and acquisition parameters as in g, obtained after a second injection of gadopentetate dimeglumine, shows the enhancing target lesion (arrowheads). On this image, the biopsy needle notch passing through the lesion is visible as faint signal void (arrows). This documents the correct needle position within the target lesion. (i) Transverse T2-weighted turbo SE image (3,000/120) obtained with the same needle position as in g with anteroposterior phase-encoding direction shows the reduced diameter of the needle-induced signal void (arrows), as compared with that in g. However, blurred image contours, probably owing to respiratory motion, also are seen. The target lesion is visible as a high-signal-intensity lesion (arrowheads).

View larger version (94K): [in a new window]   Figure 2a. MR imaging-guided 14-gauge core biopsy of the left breast in a 49-year-old high-risk patient with a familial history suggestive of breast cancer. A 6-mm lesion with suggestive enhancement had been detected at screening breast MR imaging (screening image not shown). MR imaging-guided core biopsy revealed a 6-mm focus of adenosis and epitheliosis without atypia. Because, owing to the vanishing target, the lesion was invisible during intervention, and because radiologic-pathologic mismatch could not be excluded, secondary excisional biopsy was performed after MR imaging-guided hook wire placement. Excisional biopsy findings confirmed the core biopsy diagnosis of focal adenosis without atypia. Follow-up was 8 months. (a) Transverse precontrast T1-weighted gradient-echo image (280/4.6; flip angle, 90°) from the dynamic series obtained prior to biopsy. As in Figure 1a, the breast is immobilized in the mediolateral direction by the two compression plates. The white dots (arrowheads) medial and lateral to the breast are part of the stereotactic unit’s fiducial system. (b) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a shows a 6-mm enhancing target lesion (arrowheads). (c) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a and b, obtained after administration of local anesthetic and placement of the needle phantom (arrowheads) to simulate the calculated needle trajectory, shows the lesion as only faintly visible with reversed contrast (vanishing target) because of progressive contrast enhancement in the adjacent parenchyma combined with a rapid washout of contrast material in the lesion. (d) Transverse T2-weighted turbo SE image (3,000/120) obtained after introduction of the 14-gauge core biopsy needle shows that the target at the calculated stereotactic coordinates (arrowheads) is not visible. No tissue shift is induced with the needle. (e) Transverse T2-weighted turbo SE image (3,000/120) obtained after firing the biopsy gun shows that the needle has passed exactly through the calculated position of the target (arrowheads) and that the target itself is not visible.

View larger version (110K): [in a new window]   Figure 2b. MR imaging-guided 14-gauge core biopsy of the left breast in a 49-year-old high-risk patient with a familial history suggestive of breast cancer. A 6-mm lesion with suggestive enhancement had been detected at screening breast MR imaging (screening image not shown). MR imaging-guided core biopsy revealed a 6-mm focus of adenosis and epitheliosis without atypia. Because, owing to the vanishing target, the lesion was invisible during intervention, and because radiologic-pathologic mismatch could not be excluded, secondary excisional biopsy was performed after MR imaging-guided hook wire placement. Excisional biopsy findings confirmed the core biopsy diagnosis of focal adenosis without atypia. Follow-up was 8 months. (a) Transverse precontrast T1-weighted gradient-echo image (280/4.6; flip angle, 90°) from the dynamic series obtained prior to biopsy. As in Figure 1a, the breast is immobilized in the mediolateral direction by the two compression plates. The white dots (arrowheads) medial and lateral to the breast are part of the stereotactic unit’s fiducial system. (b) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a shows a 6-mm enhancing target lesion (arrowheads). (c) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a and b, obtained after administration of local anesthetic and placement of the needle phantom (arrowheads) to simulate the calculated needle trajectory, shows the lesion as only faintly visible with reversed contrast (vanishing target) because of progressive contrast enhancement in the adjacent parenchyma combined with a rapid washout of contrast material in the lesion. (d) Transverse T2-weighted turbo SE image (3,000/120) obtained after introduction of the 14-gauge core biopsy needle shows that the target at the calculated stereotactic coordinates (arrowheads) is not visible. No tissue shift is induced with the needle. (e) Transverse T2-weighted turbo SE image (3,000/120) obtained after firing the biopsy gun shows that the needle has passed exactly through the calculated position of the target (arrowheads) and that the target itself is not visible.

View larger version (113K): [in a new window]   Figure 2c. MR imaging-guided 14-gauge core biopsy of the left breast in a 49-year-old high-risk patient with a familial history suggestive of breast cancer. A 6-mm lesion with suggestive enhancement had been detected at screening breast MR imaging (screening image not shown). MR imaging-guided core biopsy revealed a 6-mm focus of adenosis and epitheliosis without atypia. Because, owing to the vanishing target, the lesion was invisible during intervention, and because radiologic-pathologic mismatch could not be excluded, secondary excisional biopsy was performed after MR imaging-guided hook wire placement. Excisional biopsy findings confirmed the core biopsy diagnosis of focal adenosis without atypia. Follow-up was 8 months. (a) Transverse precontrast T1-weighted gradient-echo image (280/4.6; flip angle, 90°) from the dynamic series obtained prior to biopsy. As in Figure 1a, the breast is immobilized in the mediolateral direction by the two compression plates. The white dots (arrowheads) medial and lateral to the breast are part of the stereotactic unit’s fiducial system. (b) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a shows a 6-mm enhancing target lesion (arrowheads). (c) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a and b, obtained after administration of local anesthetic and placement of the needle phantom (arrowheads) to simulate the calculated needle trajectory, shows the lesion as only faintly visible with reversed contrast (vanishing target) because of progressive contrast enhancement in the adjacent parenchyma combined with a rapid washout of contrast material in the lesion. (d) Transverse T2-weighted turbo SE image (3,000/120) obtained after introduction of the 14-gauge core biopsy needle shows that the target at the calculated stereotactic coordinates (arrowheads) is not visible. No tissue shift is induced with the needle. (e) Transverse T2-weighted turbo SE image (3,000/120) obtained after firing the biopsy gun shows that the needle has passed exactly through the calculated position of the target (arrowheads) and that the target itself is not visible.

View larger version (90K): [in a new window]   Figure 2d. MR imaging-guided 14-gauge core biopsy of the left breast in a 49-year-old high-risk patient with a familial history suggestive of breast cancer. A 6-mm lesion with suggestive enhancement had been detected at screening breast MR imaging (screening image not shown). MR imaging-guided core biopsy revealed a 6-mm focus of adenosis and epitheliosis without atypia. Because, owing to the vanishing target, the lesion was invisible during intervention, and because radiologic-pathologic mismatch could not be excluded, secondary excisional biopsy was performed after MR imaging-guided hook wire placement. Excisional biopsy findings confirmed the core biopsy diagnosis of focal adenosis without atypia. Follow-up was 8 months. (a) Transverse precontrast T1-weighted gradient-echo image (280/4.6; flip angle, 90°) from the dynamic series obtained prior to biopsy. As in Figure 1a, the breast is immobilized in the mediolateral direction by the two compression plates. The white dots (arrowheads) medial and lateral to the breast are part of the stereotactic unit’s fiducial system. (b) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a shows a 6-mm enhancing target lesion (arrowheads). (c) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a and b, obtained after administration of local anesthetic and placement of the needle phantom (arrowheads) to simulate the calculated needle trajectory, shows the lesion as only faintly visible with reversed contrast (vanishing target) because of progressive contrast enhancement in the adjacent parenchyma combined with a rapid washout of contrast material in the lesion. (d) Transverse T2-weighted turbo SE image (3,000/120) obtained after introduction of the 14-gauge core biopsy needle shows that the target at the calculated stereotactic coordinates (arrowheads) is not visible. No tissue shift is induced with the needle. (e) Transverse T2-weighted turbo SE image (3,000/120) obtained after firing the biopsy gun shows that the needle has passed exactly through the calculated position of the target (arrowheads) and that the target itself is not visible.

View larger version (86K): [in a new window]   Figure 2e. MR imaging-guided 14-gauge core biopsy of the left breast in a 49-year-old high-risk patient with a familial history suggestive of breast cancer. A 6-mm lesion with suggestive enhancement had been detected at screening breast MR imaging (screening image not shown). MR imaging-guided core biopsy revealed a 6-mm focus of adenosis and epitheliosis without atypia. Because, owing to the vanishing target, the lesion was invisible during intervention, and because radiologic-pathologic mismatch could not be excluded, secondary excisional biopsy was performed after MR imaging-guided hook wire placement. Excisional biopsy findings confirmed the core biopsy diagnosis of focal adenosis without atypia. Follow-up was 8 months. (a) Transverse precontrast T1-weighted gradient-echo image (280/4.6; flip angle, 90°) from the dynamic series obtained prior to biopsy. As in Figure 1a, the breast is immobilized in the mediolateral direction by the two compression plates. The white dots (arrowheads) medial and lateral to the breast are part of the stereotactic unit’s fiducial system. (b) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a shows a 6-mm enhancing target lesion (arrowheads). (c) Transverse postcontrast T1-weighted gradient-echo image with acquisition parameters equivalent to those in a and b, obtained after administration of local anesthetic and placement of the needle phantom (arrowheads) to simulate the calculated needle trajectory, shows the lesion as only faintly visible with reversed contrast (vanishing target) because of progressive contrast enhancement in the adjacent parenchyma combined with a rapid washout of contrast material in the lesion. (d) Transverse T2-weighted turbo SE image (3,000/120) obtained after introduction of the 14-gauge core biopsy needle shows that the target at the calculated stereotactic coordinates (arrowheads) is not visible. No tissue shift is induced with the needle. (e) Transverse T2-weighted turbo SE image (3,000/120) obtained after firing the biopsy gun shows that the needle has passed exactly through the calculated position of the target (arrowheads) and that the target itself is not visible.