Skip to main content
Top
Published in: European Radiology 2/2010

01-02-2010 | Breast

Diagnostic value of MR elastography in addition to contrast-enhanced MR imaging of the breast—initial clinical results

Authors: Katja C. Siegmann, Tanja Xydeas, Ralph Sinkus, Bernhard Kraemer, Ulrich Vogel, Claus D. Claussen

Published in: European Radiology | Issue 2/2010

Login to get access

Abstract

Objective

The purpose of the study was to assess the additional value of magnetic resonance (MR) elastography (MRE) to contrast-enhanced (ce) MR imaging (MRI) for breast lesion characterisation.

Methods

Fifty-seven suspected breast lesions in 57 patients (mean age 52.4 years) were examined by ce MRI and MRE. All lesions were classified into BI-RADS categories. Viscoelastic parameters, e.g. α0 as an indicator of tissue stiffness, were calculated. Histology of the lesions was correlated with BI-RADS and viscoelastic properties. The positive predictive value (PPV) for malignancy, and the sensitivity and specificity of ce MRI were calculated. Receiver-operating characteristics (ROC) curves were separately calculated for both ce MRI and viscoelastic properties and conjoined to analyse the accuracy of diagnostic performance.

Results

The lesions (mean size 27.6 mm) were malignant in 64.9% (n = 37) of cases. The PPV for malignancy was significantly (p < 0.0001) dependent on BI-RADS classification. The sensitivity of ce MRI for breast cancer detection was 97.3% (36/37), whereas specificity was 55% (11/20). If ce MRI was combined with α0, the diagnostic accuracy could be significantly increased (p < 0.05; AUCceMRI = 0.93, AUCcombined = 0.96).

Conclusions

In this study, the combination of MRE and ce MRI could increase the diagnostic performance of breast MRI. Further investigations of larger cohorts and smaller lesions (in particular those only visible on MRI) are necessary to validate these results.
Literature
1.
go back to reference Stomper PC, Winston JS, Herman S et al (1997) Angiogenesis and dynamic MR imaging gadolinium enhancement of malignant and benign breast lesions. Breast Cancer Res Treat 45:39–46CrossRefPubMed Stomper PC, Winston JS, Herman S et al (1997) Angiogenesis and dynamic MR imaging gadolinium enhancement of malignant and benign breast lesions. Breast Cancer Res Treat 45:39–46CrossRefPubMed
3.
go back to reference Kuhl C (2007) The current status of breast MR Imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378CrossRefPubMed Kuhl C (2007) The current status of breast MR Imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378CrossRefPubMed
4.
go back to reference Morris EA, Liberman L, Ballon DJ et al (2003) MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 181:619–626PubMed Morris EA, Liberman L, Ballon DJ et al (2003) MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 181:619–626PubMed
5.
go back to reference Deurloo E, Muller SH, Peterse JL (2005) Clinically and mammographically occult breast lesions on MR Images: potential effect of computerized assessment of clinical reading. Radiology 234:693–701CrossRefPubMed Deurloo E, Muller SH, Peterse JL (2005) Clinically and mammographically occult breast lesions on MR Images: potential effect of computerized assessment of clinical reading. Radiology 234:693–701CrossRefPubMed
6.
go back to reference Van Goethem M, Schelfout K, Dijckmans L et al (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14:809–816CrossRefPubMed Van Goethem M, Schelfout K, Dijckmans L et al (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14:809–816CrossRefPubMed
7.
go back to reference American College of Radiology (ACR) (2003) Breast imaging reporting and data system (BI-RADS) atlas, 3rd edn. American College of Radiology, Reston American College of Radiology (ACR) (2003) Breast imaging reporting and data system (BI-RADS) atlas, 3rd edn. American College of Radiology, Reston
8.
go back to reference Mann RM, Kuhl CK, Kinkel K et al (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1308CrossRefPubMed Mann RM, Kuhl CK, Kinkel K et al (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1308CrossRefPubMed
9.
go back to reference Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888PubMed Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888PubMed
10.
go back to reference Baum F, Fischer U, Vosshenrich R et al (2002) Classification of hypervascularized lesions in CE MR imaging of the breast. Eur Radiol 12:1087–1092CrossRefPubMed Baum F, Fischer U, Vosshenrich R et al (2002) Classification of hypervascularized lesions in CE MR imaging of the breast. Eur Radiol 12:1087–1092CrossRefPubMed
11.
go back to reference Kuhl CK, Schild HH (2000) Dynamic image interpretation of MRI of the breast. J Magn Reson Imaging 12:965–974CrossRefPubMed Kuhl CK, Schild HH (2000) Dynamic image interpretation of MRI of the breast. J Magn Reson Imaging 12:965–974CrossRefPubMed
12.
go back to reference Siegmann KC, Mueller-Schimpfle M, Schick F et al (2002) MR imaging-detected breast lesions: histopathologic correlation of lesion characteristics and signal intensity data. AJR Am J Roentgenol 178:1403–1409PubMed Siegmann KC, Mueller-Schimpfle M, Schick F et al (2002) MR imaging-detected breast lesions: histopathologic correlation of lesion characteristics and signal intensity data. AJR Am J Roentgenol 178:1403–1409PubMed
13.
go back to reference Meng L, Zhou J, Sasano H et al (2001) Tumor necrosis factor alpha and interleukin 11 secreted by malignant breast epithelial cells inhibit adipocyte differentiation by selectively down-regulating CCAAT/enhancer binding protein alpha and peroxisome proliferator-activated receptor gamma: mechanism of desmoplastic reaction. Cancer Res 61:2250–2055PubMed Meng L, Zhou J, Sasano H et al (2001) Tumor necrosis factor alpha and interleukin 11 secreted by malignant breast epithelial cells inhibit adipocyte differentiation by selectively down-regulating CCAAT/enhancer binding protein alpha and peroxisome proliferator-activated receptor gamma: mechanism of desmoplastic reaction. Cancer Res 61:2250–2055PubMed
14.
go back to reference Saslow D, Hannan J, Osuch J et al (2004) Clinical breast examination: practical recommendations for optimizing performance and reporting. Cancer J Clin 54:327–344CrossRef Saslow D, Hannan J, Osuch J et al (2004) Clinical breast examination: practical recommendations for optimizing performance and reporting. Cancer J Clin 54:327–344CrossRef
15.
go back to reference Feigin KN, Keating DM, Telford PM et al (2006) Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology 240:650–655CrossRefPubMed Feigin KN, Keating DM, Telford PM et al (2006) Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology 240:650–655CrossRefPubMed
16.
go back to reference Bancej C, Decker K, Chiarelli A et al (2003) Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen 10:16–21CrossRefPubMed Bancej C, Decker K, Chiarelli A et al (2003) Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen 10:16–21CrossRefPubMed
17.
go back to reference Tan SM, The HS, Mancer JF et al (2007) Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—a clinical approach. Breast 17:252–257CrossRefPubMed Tan SM, The HS, Mancer JF et al (2007) Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—a clinical approach. Breast 17:252–257CrossRefPubMed
18.
go back to reference Tohno E, Ueno E (2008) Current improvements in breast ultrasound, with a special focus on elastography. Breast Cancer 15:200–204CrossRefPubMed Tohno E, Ueno E (2008) Current improvements in breast ultrasound, with a special focus on elastography. Breast Cancer 15:200–204CrossRefPubMed
19.
go back to reference Zhu QL, Jiang XY, Liu JB et al (2008) Real-time ultrasound elastography: its potential role in assessment of breast lesions. Ultrasound Med Biol 34:1232–1238CrossRefPubMed Zhu QL, Jiang XY, Liu JB et al (2008) Real-time ultrasound elastography: its potential role in assessment of breast lesions. Ultrasound Med Biol 34:1232–1238CrossRefPubMed
20.
go back to reference Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–350CrossRefPubMed Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–350CrossRefPubMed
21.
go back to reference Sinkus R, Lorenzen J, Schrader D et al (2000) High-resolution tensor MR elastography for breast tumour detection. Phys Med Biol 45:1649–1664CrossRefPubMed Sinkus R, Lorenzen J, Schrader D et al (2000) High-resolution tensor MR elastography for breast tumour detection. Phys Med Biol 45:1649–1664CrossRefPubMed
22.
go back to reference Von Houten EEW, Doyley MM, Kennedy FE (2003) Initial in vivo experience with steady-state subzone-based MR elastography of the human breast. J Magn Reson Imaging 17:72–85CrossRefPubMed Von Houten EEW, Doyley MM, Kennedy FE (2003) Initial in vivo experience with steady-state subzone-based MR elastography of the human breast. J Magn Reson Imaging 17:72–85CrossRefPubMed
23.
go back to reference Sinkus R, Tanter M, Xydeas T et al (2005) Viscoelastic shear properties of in vivo breast lesions measured by MR elastography. Magn Reson Imaging 23:159–165CrossRefPubMed Sinkus R, Tanter M, Xydeas T et al (2005) Viscoelastic shear properties of in vivo breast lesions measured by MR elastography. Magn Reson Imaging 23:159–165CrossRefPubMed
24.
go back to reference Sinkus R, Tanter M, Catheline S et al (2005) Imaging anisotropic and viscous properties of breast tissue by magnetic resonance-elastography. Magn Reson Med 53:372–387CrossRefPubMed Sinkus R, Tanter M, Catheline S et al (2005) Imaging anisotropic and viscous properties of breast tissue by magnetic resonance-elastography. Magn Reson Med 53:372–387CrossRefPubMed
25.
go back to reference Plewes DB, Bishop J, Samani A et al (2000) Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography. Phys Med Biol 45:1591–1610CrossRefPubMed Plewes DB, Bishop J, Samani A et al (2000) Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography. Phys Med Biol 45:1591–1610CrossRefPubMed
26.
go back to reference McKnight AL, Kugel JL, Rossmann PJ et al (2002) MR elastography of breast cancer: preliminary results. AJR Am J Roentgenol 178:1411–1417PubMed McKnight AL, Kugel JL, Rossmann PJ et al (2002) MR elastography of breast cancer: preliminary results. AJR Am J Roentgenol 178:1411–1417PubMed
27.
go back to reference Sinkus R, Tanter M, Bercoff J et al (2008) Potential of MRI and Ultrasound Radiation Force in Elastography: Applications to Diagnosis and Therapy. Proc IEEE 96:490–499CrossRef Sinkus R, Tanter M, Bercoff J et al (2008) Potential of MRI and Ultrasound Radiation Force in Elastography: Applications to Diagnosis and Therapy. Proc IEEE 96:490–499CrossRef
28.
go back to reference Lorenzen J, Sinkus R, Biesterfeldt M et al (2003) Menstrual-cycle dependence of breast parenchyma elasticity: estimation with magnetic resonance elastography of breast tissue during the menstrual cycle. Invest Radiol 38:236–240CrossRefPubMed Lorenzen J, Sinkus R, Biesterfeldt M et al (2003) Menstrual-cycle dependence of breast parenchyma elasticity: estimation with magnetic resonance elastography of breast tissue during the menstrual cycle. Invest Radiol 38:236–240CrossRefPubMed
29.
go back to reference Sinkus R, Siegmann K, Xydeas T et al (2007) MR elastography of breast lesions: understanding the solid/liquid duality can improve the specificity of contrast-enhanced MR mammography. Magn Reson Med 58:1135–1144CrossRefPubMed Sinkus R, Siegmann K, Xydeas T et al (2007) MR elastography of breast lesions: understanding the solid/liquid duality can improve the specificity of contrast-enhanced MR mammography. Magn Reson Med 58:1135–1144CrossRefPubMed
30.
go back to reference Tavassoli FA, Devillee P (2006) World health organization classification of tumors. Pathology and genetics. Tumours of the breast and female genital organs. IARC Press Lyon Tavassoli FA, Devillee P (2006) World health organization classification of tumors. Pathology and genetics. Tumours of the breast and female genital organs. IARC Press Lyon
31.
go back to reference Perry N, Broeders M, de Wolf C et al (2006) European commission: European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. Office of Official Publications of the European Communities, Luxembourg Perry N, Broeders M, de Wolf C et al (2006) European commission: European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. Office of Official Publications of the European Communities, Luxembourg
32.
go back to reference Lorenzen J, Sinkus R, Lorenzen M et al (2002) MR elastography of the breast: preliminary clinical results. Rofo 174:830–834PubMed Lorenzen J, Sinkus R, Lorenzen M et al (2002) MR elastography of the breast: preliminary clinical results. Rofo 174:830–834PubMed
33.
go back to reference Xydeas T, Siegmann KC, Sinkus R et al (2005) Magnetic resonance elastography of the breast—correlation of signal intensity data and viscoelastic properties. Invest Radiol 40:412–420CrossRefPubMed Xydeas T, Siegmann KC, Sinkus R et al (2005) Magnetic resonance elastography of the breast—correlation of signal intensity data and viscoelastic properties. Invest Radiol 40:412–420CrossRefPubMed
34.
go back to reference Ou JJ, Ong RE, Yankeelov TE et al (2008) Evaluation of 3D modality-independent elastography for breast imaging: a simulation study. Phys Med Biol 53:147–163CrossRefPubMed Ou JJ, Ong RE, Yankeelov TE et al (2008) Evaluation of 3D modality-independent elastography for breast imaging: a simulation study. Phys Med Biol 53:147–163CrossRefPubMed
35.
go back to reference Glaser KJ, Felmlee JP, Ehman RL (2006) Rapid MR elastography using selective excitations. Magn Reson Med 55:1381–1389CrossRefPubMed Glaser KJ, Felmlee JP, Ehman RL (2006) Rapid MR elastography using selective excitations. Magn Reson Med 55:1381–1389CrossRefPubMed
Metadata
Title
Diagnostic value of MR elastography in addition to contrast-enhanced MR imaging of the breast—initial clinical results
Authors
Katja C. Siegmann
Tanja Xydeas
Ralph Sinkus
Bernhard Kraemer
Ulrich Vogel
Claus D. Claussen
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
European Radiology / Issue 2/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1566-4

Other articles of this Issue 2/2010

European Radiology 2/2010 Go to the issue