Comstock Christopher E. - Breast MRI Teaching Atlas

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Springer New York 2017

Richard Ha , Christopher E. Comstock and Elizabeth A. Morris (eds.) Breast MRI Teaching Atlas 10.1007/978-1-4939-6409-3_1

1. Breast MRI Basics

Victoria Mango 1

(1)

Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Assistant Professor of Radiology, Weill Cornell Medical College, New York, NY, USA

(2)

Breast Imaging Section, Associate Professor of Radiology, University of Washington School of Medicine, Seattle, Washington, USA

(3)

Division of Breast Imaging, Associate Professor of Radiology, Columbia University Medical Center, New York, NY, USA

(4)

Division of Breast Imaging, Assistant Professor of Radiology, Columbia University Medical Center, New York, NY, USA

(5)

Division of Breast Imaging, Assistant Professor of Radiology, Columbia University Medical Center, New York, NY, USA

Victoria Mango Director of Breast and Body Imaging Fellowship

Email:

Habib Rahbar

Email:

Ralph Wynn Section Head

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Lauren Friedlander Director of Breast and Body Imaging Fellowship

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Richard Ha Director of Education and Research (Corresponding author)

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Keywords

Fibroglandular tissue Background parenchymal enhancement Maximum intensity projection Kinetics

1.1 History

Four patients with T1-weighted sequence findings (Figs. ).

Fig. 1.1

Sagittal T1 fat-saturated pre-contrast image of the right breast

Fig. 1.2

Sagittal T1 fat-saturated post-contrast image of the right breast ( a ) and corresponding T1 nonfat-saturated image ( b )

Fig. 1.3

Sagittal T1 nonfat-saturated image of the left breast

Fig. 1.4

Sagittal T1 nonfat-saturated image of the right breast ( a ) and corresponding T1 fat-saturated sequences ( b )

1.2 T1-Weighted Sequence

Teaching Points

Breast MRI should be performed on systems with at least 1.5 Tesla magnet strength with a dedicated breast coil. Usually, a pre-contrast T1-weighted gradient-echo sequence without fat saturation is the first sequence performed after the scout images. A T1-weighted nonfat-saturated sequence is obtained bilaterally, including axillae and chest wall, to distinguish fat from water-based tissues. The pre-contrast T1-weighted sequence is typically used to assess the amount of fibroglandular tissue and can be particularly helpful in documenting the presence of high-signal hemorrhagic or proteinaceous fluid-filled, dilated ducts (Fig. ).

Image Findings

Fig. 1.5

Hemorrhagic or proteinaceous debris in ducts. Sagittal T1 fat-saturated pre-contrast image of the right breast demonstrates several linear hyperintensities ( arrows ) in a ductal distribution in the lower breast, compatible with hemorrhagic or proteinaceous debris

Fig. 1.6

Fat necrosis. ( a ) Sagittal T1 fat-saturated post-contrast image of the right breast demonstrates indeterminate rim enhancement ( arrows ). ( b ) The T1 nonfat-saturated image shows central fat ( arrow ), compatible with benign fat necrosis

Fig. 1.7

Architectural distortion. In a patient with prior lumpectomy, the sagittal T1 nonfat-saturated image of the left breast illustrates architectural distortion in the central breast ( arrows ) and associated nipple retraction ( arrowhead )

Fig. 1.8

Susceptibility artifact from biopsy clip. The susceptibility artifact from a biopsy clip ( arrow ) is more prominent on the T1 nonfat-saturated image of the right breast ( a ) than on the T1 fat-saturated sequences ( b )

1.3 History

Four patients illustrating the range of the amount of fibroglandular tissue on breast MRI (Figs. ).

Fig. 1.9, 1.10, 1.11, and 1.12

Selected sagittal T1 post-contrast image ( a ) right breast demonstrates an almost entirely fatty breast ( b ) right breast shows scattered fibroglandular tissue. Selected sagittal T1 pre-contrast image ( c ) right breast demonstrates heterogeneous fibroglandular tissue. Selected sagittal T1 post-contrast image ( d ) left breast demonstrates extreme fibroglandular tissue

1.4 Fibroglandular Tissue

Teaching Points

At mammography, breast density is represented by the amount of fibroglandular tissue (FGT) in contrast to fat measured in two-dimensional views that may not reflect an accurate assessment. Breast MRI provides strong soft-tissue contrast between FGT and fat, and a more accurate three-dimensional coverage of the entire breast. Evaluation of the amount of FGT is usually done on the T1-weighted sequences with and without fat suppression. According to the American College of Radiology (ACR) guidelines, the amount of FGT should be described in the Breast MRI report using the BI-RADS four assessment categories of breast composition, which are defined by the visually estimated content of FGT within the breasts.

The amount of fibroglandular tissue (breast density) has been established as an independent risk factor associated with the development of breast cancer, which is three to five times higher in women with mammographically dense breasts than in women with predominantly fatty breasts.

1.5 History

Four patients illustrating the range of background parenchymal enhancement seen on breast MRI (Figs. ).

Fig. 1.13,1.14, 1.15, and 1.16

Sagittal T1 post-contrast 3D maximum intensity projection (MIP) image ( a ) left breast demonstrates minimal background parenchymal enhancement ( b ) right breast demonstrates mild background parenchymal enhancement ( c ) right breast demonstrates moderate background parenchymal enhancement ( d ) right breast demonstrates marked background parenchymal enhancement

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