DOI: 10.1148/rg.265055176
How to Optimize Clinical Breast MR Imaging Practices and Techniques on Your 1.5-T System1
Dana R. Rausch, MD and
R. Edward Hendrick, PhD
1 From the Department of Radiology, Mount Sinai Medical Center, Box 1234, 1 Gustave L. Levy Place, New York, NY 10029 (D.R.R.); and Department of Radiology, Lynn Sage Comprehensive Breast Center, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.E.H.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received September 21, 2005; revision requested January 4, 2006, and received January 31; accepted February 6. D.R.R. has been an educational speaker for Suros Surgical Systems, and R.E.H. is an educational speaker for GE Healthcare.
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Figure 1. Axial contrast-enhanced T1-weighted fat-suppressed MR image demonstrates asymmetric diffuse heterogeneous enhancement in the left breast in a patient with infiltrating ductal carcinoma.
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Figure 2a. (a) Axial MR image obtained with a short inversion time inversion recovery sequence shows several areas of uniform high signal intensity in the breast, a finding that signifies one or more cysts. (b) Axial US image at a similar level in the breast demonstrates an oval, macrolobulated, circumscribed, horizontally oriented mass with posterior acoustic enhancement. This finding corresponds to that in a and is compatible with the diagnosis of a benign simple cyst.
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Figure 2b. (a) Axial MR image obtained with a short inversion time inversion recovery sequence shows several areas of uniform high signal intensity in the breast, a finding that signifies one or more cysts. (b) Axial US image at a similar level in the breast demonstrates an oval, macrolobulated, circumscribed, horizontally oriented mass with posterior acoustic enhancement. This finding corresponds to that in a and is compatible with the diagnosis of a benign simple cyst.
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Figure 3a. (a) Axial contrast-enhanced T1-weighted MR image acquired with improper selection of the anterior-posterior direction as the phase-encoding direction shows a resultant cardiac motion–related artifact propagated across the breasts in a vertical direction (arrows). (b) Axial T1-weighted image acquired in another patient with the left-right direction properly selected as the phase-encoding direction (arrows) provides better depiction of the breasts.
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Figure 3b. (a) Axial contrast-enhanced T1-weighted MR image acquired with improper selection of the anterior-posterior direction as the phase-encoding direction shows a resultant cardiac motion–related artifact propagated across the breasts in a vertical direction (arrows). (b) Axial T1-weighted image acquired in another patient with the left-right direction properly selected as the phase-encoding direction (arrows) provides better depiction of the breasts.
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Figure 4a. Fat suppression by means of a fat-saturation pulse. Contrast-enhanced T1-weighted MR images show inhomogeneous (a) and homogeneous (b) fat suppression.
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Figure 4b. Fat suppression by means of a fat-saturation pulse. Contrast-enhanced T1-weighted MR images show inhomogeneous (a) and homogeneous (b) fat suppression.
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Figure 5a. Fat suppression by means of image subtraction. (a, b) Sagittal T1-weighted breast MR images acquired before (a) and after (b) contrast agent injection and without a fat-saturation pulse. (c) Subtraction image of the same section as in a and b demonstrates an enhanced mass and several artifacts that mimic areas of contrast agent uptake. The artifacts were caused by signal misregistration between images acquired before and after contrast agent administration.
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Figure 5b. Fat suppression by means of image subtraction. (a, b) Sagittal T1-weighted breast MR images acquired before (a) and after (b) contrast agent injection and without a fat-saturation pulse. (c) Subtraction image of the same section as in a and b demonstrates an enhanced mass and several artifacts that mimic areas of contrast agent uptake. The artifacts were caused by signal misregistration between images acquired before and after contrast agent administration.
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Figure 5c. Fat suppression by means of image subtraction. (a, b) Sagittal T1-weighted breast MR images acquired before (a) and after (b) contrast agent injection and without a fat-saturation pulse. (c) Subtraction image of the same section as in a and b demonstrates an enhanced mass and several artifacts that mimic areas of contrast agent uptake. The artifacts were caused by signal misregistration between images acquired before and after contrast agent administration.
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Figure 6a. Effect of section thickness on tissue visibility and image quality. Breast MR images obtained with 1-mm (a), 2-mm (b), 3-mm (c), and 4-mm (d) section thicknesses show that as section thickness increases, SNR also increases, but so does the severity of the partial volume artifact (blurring of tissue margins).
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Figure 6b. Effect of section thickness on tissue visibility and image quality. Breast MR images obtained with 1-mm (a), 2-mm (b), 3-mm (c), and 4-mm (d) section thicknesses show that as section thickness increases, SNR also increases, but so does the severity of the partial volume artifact (blurring of tissue margins).
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Figure 6c. Effect of section thickness on tissue visibility and image quality. Breast MR images obtained with 1-mm (a), 2-mm (b), 3-mm (c), and 4-mm (d) section thicknesses show that as section thickness increases, SNR also increases, but so does the severity of the partial volume artifact (blurring of tissue margins).
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Figure 6d. Effect of section thickness on tissue visibility and image quality. Breast MR images obtained with 1-mm (a), 2-mm (b), 3-mm (c), and 4-mm (d) section thicknesses show that as section thickness increases, SNR also increases, but so does the severity of the partial volume artifact (blurring of tissue margins).
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Figure 7. Typical time-enhancement curves. Type III (gray curve) and type II (black curve) lesion enhancement can be accurately distinguished at 11/4 minutes after contrast material administration (vertical dashed line), but the distinction is lost with delayed imaging at 4 minutes (vertical solid line).
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Figure 8a. T1-weighted fat-suppressed breast MR images. (a) Axial image obtained in a single bilateral breast section before contrast agent injection. (b) Axial contrast-enhanced image in the same section as a demonstrates segmentally distributed areas of clumped heterogeneous enhancement in the left breast (arrow). (c) Axial image obtained in another bilateral breast section before contrast agent injection. (d) Axial contrast-enhanced image in the same section as c demonstrates a lobulated, heterogeneously enhanced, irregularly marginated mass (arrow). (e) Maximum intensity projection of the entire set of axial images shows both enhanced lesions in the left breast (arrows).
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Figure 8b. T1-weighted fat-suppressed breast MR images. (a) Axial image obtained in a single bilateral breast section before contrast agent injection. (b) Axial contrast-enhanced image in the same section as a demonstrates segmentally distributed areas of clumped heterogeneous enhancement in the left breast (arrow). (c) Axial image obtained in another bilateral breast section before contrast agent injection. (d) Axial contrast-enhanced image in the same section as c demonstrates a lobulated, heterogeneously enhanced, irregularly marginated mass (arrow). (e) Maximum intensity projection of the entire set of axial images shows both enhanced lesions in the left breast (arrows).
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Figure 8c. T1-weighted fat-suppressed breast MR images. (a) Axial image obtained in a single bilateral breast section before contrast agent injection. (b) Axial contrast-enhanced image in the same section as a demonstrates segmentally distributed areas of clumped heterogeneous enhancement in the left breast (arrow). (c) Axial image obtained in another bilateral breast section before contrast agent injection. (d) Axial contrast-enhanced image in the same section as c demonstrates a lobulated, heterogeneously enhanced, irregularly marginated mass (arrow). (e) Maximum intensity projection of the entire set of axial images shows both enhanced lesions in the left breast (arrows).
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Figure 8d. T1-weighted fat-suppressed breast MR images. (a) Axial image obtained in a single bilateral breast section before contrast agent injection. (b) Axial contrast-enhanced image in the same section as a demonstrates segmentally distributed areas of clumped heterogeneous enhancement in the left breast (arrow). (c) Axial image obtained in another bilateral breast section before contrast agent injection. (d) Axial contrast-enhanced image in the same section as c demonstrates a lobulated, heterogeneously enhanced, irregularly marginated mass (arrow). (e) Maximum intensity projection of the entire set of axial images shows both enhanced lesions in the left breast (arrows).
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Figure 8e. T1-weighted fat-suppressed breast MR images. (a) Axial image obtained in a single bilateral breast section before contrast agent injection. (b) Axial contrast-enhanced image in the same section as a demonstrates segmentally distributed areas of clumped heterogeneous enhancement in the left breast (arrow). (c) Axial image obtained in another bilateral breast section before contrast agent injection. (d) Axial contrast-enhanced image in the same section as c demonstrates a lobulated, heterogeneously enhanced, irregularly marginated mass (arrow). (e) Maximum intensity projection of the entire set of axial images shows both enhanced lesions in the left breast (arrows).
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Figure 9. Sagittal contrast-enhanced T1-weighted fat-suppressed image shows an irregular, heterogeneously enhanced mass with a thick peripheral rim, a finding that represents an invasive ductal carcinoma. Note the superficial enhanced vessels in the superior portion of the breast.
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Figure 10a. Ductal carcinoma in situ. (a) Sagittal contrast-enhanced T1-weighted fat-suppressed image shows segmentally distributed areas of clumped enhancement in the inferior portion of the breast, a typical finding of ductal carcinoma in situ. (b) Sagittal contrast-enhanced T1-weighted fat-suppressed image demonstrates areas of clumped enhancement in a linear configuration in the breast of another patient who presented with a malignant axillary lymph node. Findings at mammography and US were unremarkable. Results of pathologic analysis helped confirm the diagnosis of ductal carcinoma in situ in both cases.
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Figure 10b. Ductal carcinoma in situ. (a) Sagittal contrast-enhanced T1-weighted fat-suppressed image shows segmentally distributed areas of clumped enhancement in the inferior portion of the breast, a typical finding of ductal carcinoma in situ. (b) Sagittal contrast-enhanced T1-weighted fat-suppressed image demonstrates areas of clumped enhancement in a linear configuration in the breast of another patient who presented with a malignant axillary lymph node. Findings at mammography and US were unremarkable. Results of pathologic analysis helped confirm the diagnosis of ductal carcinoma in situ in both cases.
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Figure 11. Schematic drawing of time-enhancement curve types. The type I curve (dotted black line) indicates persistent enhancement throughout the examination. The curve for type II (solid black line) shows peak enhancement at 2–3 minutes after contrast agent injection, followed by a plateau. The type III curve (gray line) shows peak enhancement followed by washout with a steady decrease in signal intensity.
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Figure 12. Axial contrast-enhanced T1-weighted fat-suppressed image shows three enhanced, smooth, lobulated masses with low-signal-intensity internal septa. These findings represented fibroadenomas, which were confirmed at excisional biopsy.
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Figure 13. Breast MR image shows artifacts due to magnetic field inhomogeneity (arrows) generated by metallic surgical clips placed during a previous lumpectomy.
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Copyright © 2006 by the Radiological Society of North America.
