Breast MRI: State of the Art and Future Directions

Front Cover
Breast MRI
Advances in Magnetic Resonance Technology and Applications Series
Breast MRI State of the Art and Future Directions
Copyright
Contents
Contributors
Preface
1 -
State of the art
1 -
Performance and interpretation of breast MRI
1 - Multiparametric breast MRI in clinical practice
Introduction
T1-weighted imaging
Standard dynamic contrast-enhanced MRI
T2-weighted imaging
Diffusion-weighted imaging
Other specific imaging sequences
References
2 - Abbreviated and Ultrafast MRI
Introduction
Abbreviated MRI protocols
Recent MRI screening studies
Benefits and challenges of abbreviated MRI
Ultrafast MRI (high temporal resolution MRI)
Hybrid imaging—abbreviated ultrafast MRI
Recent MRI screening studies
Conclusions
References
3 - Artifacts in breast MRI
Introduction
Motion artifacts
Fat
Chemical shift artifact of the first kind
Chemical shift artifact of the second kind
Artifacts related to fat suppression
Susceptibility
Other artifacts
Conclusions
References
4 - Standard terminology and reporting– Breast Imaging Reporting & Data System: magnetic resonance imaging
Introduction
Standard terminology
Descriptors of breast tissue composition
Descriptors of enhancing lesions
Focus
Mass
Nonmass enhancement
Other descriptors
Intramammary lymph node
Skin lesion
Nonenhancing findings
Associated features
Fat-containing lesions
Location of lesion
Kinetic curve assessment
Implants
Reporting
Conclusions
References
5 - The Kaiser score: an evidence-based clinical decision rule for dynamic contrast-enhanced breast MRI
Introduction: why do we need the Kaiser score in breast MRI?
Description of the Kaiser score and its criteria
Diagnostic criteria
Spiculations (Dr. Kaiser's “root sign”)
Dynamic enhancement characteristics (enhancement curve type)
Margins
Internal enhancement characteristics
Edema
The Kaiser score
Application of the Kaiser score in clinical practice
Considering the clinical context
Future directions: integration with other biomarkers and automated analyses
Conclusions
References
6 - Background parenchymal enhancement at breast MRI
Introduction
MRI appearance of BPE
BPE, breast density, and FGT
Biological basis of BPE
Factors influencing BPE
BPE and diagnostic performance
Qualitative and quantitative assessments of BPE
Region-of-interest-based approach
Segmentation-based approach
BPE and breast cancer risk
BPE and treatment outcomes
Selective estrogen receptor modulator and aromatase inhibitor therapy
Neoadjuvant chemotherapy, pCR, and RFS
Conclusions
References
2 -
MRI characteristics of common breast lesions
7 - MRI characteristics of benign lesions
Introduction
Developmental abnormalities
Fibroadenolipomas (hamartomas)
Lipomas
Leiomyomas and hemangiomas
Fibroadenomas
Phyllodes tumor
Cysts
Fibrocystic changes
Adenosis
Infectious and inflammatory conditions
Idiopathic granulomatous mastitis
Pseudoangiomatous stromal hyperplasia
Conclusions
References
8 - MRI characteristics of high-risk lesions
Introduction
Histopathological characteristics
Imaging findings at conventional imaging
Imaging findings at breast MRI
Management
New frontiers
References
Further reading
9 - MRI characteristics of ductal carcinoma in situ
Introduction
Clinical presentations and pathologic features of DCIS
Appearance of DCIS on dynamic contrast-enhanced MRI
DCIS appearance on advanced MRI techniques
Diffusion-weighted imaging
Ultrafast MRI
MRI performance to assess the extent of DCIS
Future directions: MRI to assess biology and prognosis
Conclusions
References
10 - MRI characteristics of invasive breast cancer
Introduction
Invasive ductal carcinoma
Imaging presentation
Invasive lobular carcinoma
Imaging presentation
Uncommon histologic subtypes of invasive breast cancer
Mucinous carcinoma
Tubular carcinoma
Medullary carcinoma
Papillary carcinoma
Metaplastic carcinoma
Special presentations of invasive breast cancer
Paget disease of the breast
Inflammatory breast cancer
Conclusions
References
3: Clinical indications for breast MRI
11 - Breast MRI for screening
Introduction
Screening
Early studies on screening for breast cancer with MRI
The performance of MRI screening in women at increased risk
Screening in specific risk groups
BRCA1 and BRCA2
Women with a history of radiation to the chest
Other hereditary risk groups
Familial risk
Women with a personal history of breast cancer
Women with high-risk lesion on biopsy
Women with extremely or heterogeneously dense breasts
Women at average risk
Shortcomings of screening
Undergoing the screening examination
False-negative examinations
False-positive screening examinations
Overdiagnosis
Additional screening methods for women undergoing breast MRI
Clinical breast examination
Ultrasound
Mammography
General guidance
References
12 - Breast MRI for staging and treatment planning
Introduction to the role of breast MRI
MRI for staging
Breast cancer staging overview
Extent of disease
Tumor size
Locally advanced disease
Multifocal, multicentric, and contralateral disease
Nodal disease
Metastatic disease
Special situations
Treatment planning
Anatomic structures that impact treatment planning
Ductal carcinoma in situ
Invasive lobular carcinoma
Molecular subtypes
Impact of MRI on surgical outcomes
Conclusions
References
13 - Neoadjuvant therapy response assessment with breast MRI
Introduction
Pathologic measures of neoadjuvant therapy response
Dynamic contrast-enhanced MRI, diffusion-weighted imaging, and MR spectroscopy: correlation with pathologic complete response
Predicting response early in the course of therapy
Diffusion-weighted imaging and response assessment
MR spectroscopy
Quantitative MRI metrics
Ultrafast/accelerated breast MRI
Monitoring chemotherapy response in the axilla
Conclusions
References
14 - Breast MRI for post-treatment follow-up
Introduction
Posttreatment changes
Recurrent breast cancer
References
15 - Breast augmentation and postmastectomy autologous breast reconstruction on breast MRI
Introduction
Breast augmentation and implant-based reconstruction
Breast implants
Implant-based reconstruction
Imaging evaluation of the breast after reconstructive surgery
Imaging evaluation of the breast after primary augmentation
MRI acquisition
MRI-specific findings
Normal findings
Complications of implant-related surgery and findings on MRI
Intracapsular rupture pitfalls and mimics
Extracapsular rupture pitfalls and mimics
Free silicone injection
Free-fat injection, lipofilling, lipomodeling, or autologous fat grafting
Autologous flaps
Latissimus dorsi flap
TRAM (transverse rectus abdominus muscle) flap
DIEP (deep inferior epigastric perforator) flap
References
16 - Problem-solving breast MRI
Introduction
Evaluation of suspicious symptoms, including nipple discharge
Nipple discharge
Palpable lumps
Breast pain
Equivocal imaging findings
Empirical evidence
Masses
Calcifications
Architectural distortion
Asymmetry
Conclusions
References
17 - Imaging of the axilla and cancer of unknown primary
Introduction
Anatomy of the axilla
Spread of metastatic disease to axillary lymph nodes
Evaluation of axillary lymph nodes
MR imaging of the axilla
Detection of abnormal axillary lymph nodes on MRI
Clinical management of metastatic axillary lymph nodes
Surgical approach: axillary lymph node dissection and sentinel lymph node biopsy
Radiotherapy
Chemotherapy
The controversial role of imaging in axillary staging
Role of MRI in the detection and treatment of occult primary breast cancer
Interventional techniques for axillary lymph node localization and breast MRI
Future directions
Artificial intelligence-based axillary lymph node classification using breast MRI
Conclusions
References
Further reading
4 -
Breast magnetic resonance imaging–guided interventions and therapy
18 - Biopsy, including MRI-directed US and rad-path correlation
Introduction
History of MRI-guided techniques
MRI-guided biopsy
Imaging review
Consent process, contraindications, and risk
Equipment
The procedure: positioning, protocol, percutaneous biopsy
Positioning
Protocol
Percutaneous biopsy
MRI localization
MRI-guided clip placement with subsequent mammographic/sonographic localization
MRI-directed skin localization with subsequent excisional biopsy
MRI-guided wire localization
Wire-free MRI localization
MRI-directed ultrasound
Radiologic–pathologic correlation
Current challenges and future directions
Conclusions
References
19 - MRI-guided minimally invasive therapy of breast lesions
Introduction
State of the art and methodologies
Radiofrequency ablation
Laser-induced thermal therapy
High-intensity focused ultrasound
Cryoablation
Applications in breast care
Current challenges and future directions
Conclusions
References
2 -
Future directions
5 -
Advanced and emerging approaches
20
- Noncontrast MRI
Introduction
Diffusion-weighted MRI
DW MRI as a supplement to conventional DCE-MRI
Cancer diagnosis
Cancer prognosis
Lymph node evaluation
Cancer response to treatment
DW MRI as a stand-alone modality
DW MRI in screening settings
Performance compared to other modalities
Mammography
DCE-MRI
Abbreviated MRI
Ultrasound
False positives and negatives
Image interpretation strategies
Technical considerations
B-value selection
Emerging techniques
Acquisition
Postprocessing
Advanced modeling
Conclusions
References
21 - Metabolic imaging using ultra-high field MRI
Introduction
Applications
MRS/MRI applications
1H MRS in the breast
23Na MRI
31P MRS
CEST applications
Chemical exchange saturation transfer
Challenges and future applications
Conclusions
References
22 - Quantitative DCE-MRI of the Breast
Introduction
Pharmacokinetic modeling of DCE-MRI data
Applications of quantitative breast DCE-MRI
Characterizing breast cancer molecular subtypes and histopathological features
Discriminating between malignant and benign breast lesions
Predicting and evaluating breast cancer response to treatment
Technical Considerations for Quantitative Breast DCE-MRI
High temporal and high spatial resolution breast DCE-MRI
Effect of water exchange and the shutter-speed PK model
Breast DCE-MRI temporal resolution
Breast DCE-MRI acquisition time
AIF and R10 determinations for quantitative breast DCE-MRI
PK model selection for breast DCE-MRI
Conclusions
References
23 - Diffusion MRI of the breast: standard and advanced techniques
Introduction
Diffusion-weighted imaging
Principles of diffusion MRI
Current status of DWI and ADC in clinical practice
Differentiation between benign and malignant breast lesions
Correlation with prognostic factors
Therapeutic response
“How to,” basic requirements, and the need for standardization
Advanced diffusion MRI
Intravoxel incoherent motion
Principles
Clinical value
“How-to” and basic requirements
Non-Gaussian diffusion
Principles
Common non-Gaussian diffusion approaches
Diffusion Kurtosis Imaging
Distributed diffusion models
Restriction spectrum imaging
Model-free approaches: sADC and S-index
Combination of IVIM and non-Gaussian diffusion MRI
Diffusion tensor imaging
Principles
Clinical value
Conclusions
References
24 - MR spectroscopy
Introduction
In vivo magnetic resonance spectroscopy technique
Data analysis
Clinical applications
Differentiation of malignant and benign lesions using tCho levels
Differentiation of malignant and benign lesions using lipid metabolites
Determination of tumor aggressiveness and molecular subtypes
Treatment response assessment
Conclusions
References
25 - Emerging techniques in breast MRI
Introduction
Ultrafast dynamic contrast-enhanced imaging
Magnetic resonance elastography
Magnetization transfer and chemical exchange saturation transfer
Magnetic resonance spectroscopy
Hyperpolarized [1-13C]-pyruvate
MRI-constrained radiomics and habitat imaging
MRI-constrained mathematical modeling
Conclusions
References
6 - Hybrid imaging and alternative techniques
26 - PET/MRI hybrid imaging and targeted tracers
Introduction
Radiotracers
FDA-approved tracers
Experimental tracers
Acquisition protocol
Breast 18F-FDG PET/MRI
Whole-body 18F-FDG PET/MRI
Clinical applications of 18F-FDG PET/MRI in breast cancer
Breast cancer detection
Breast cancer phenotyping
Breast cancer staging
Prediction/assessment of response to neoadjuvant chemotherapy
New frontiers: radiomics and artificial intelligence
Conclusions
References
27 - Competing and alternative techniques to breast MRI
Contrast-enhanced mammography
Background
Technique and reporting
Diagnostic evaluation of screen-detected abnormalities and symptomatic patients
CEM for staging
CEM for disease monitoring post neoadjuvant chemotherapy
CEM for screening
Future directions
Breast-specific gamma imaging and molecular breast imaging
Background
Technique
Screening and diagnostic evaluation
Limitations
Positron emission tomography and positron emission mammography of the breast
Future directions
References
7 -
Prognostic and predictive MR imaging biomarkers
28 - MRI radiomics and radiogenomics for breast cancer
Introduction
Image preprocessing
Feature extraction
Prognostic and predictive radiomic biomarkers for breast cancer
Radiomic biomarkers to predict histopathologic and molecular subtype
Radiomic biomarkers to predict overall and recurrence-free survival
Radiomic biomarkers to predict therapy response
Radiogenomics
Correlations between radiomic signatures and gene expression status
Correlations between radiomic signatures and biological pathways
Combined radiogenomic models for outcome prediction
Limitations and future directions
References
29 - Breast imaging and deep learning: past, present, and future
Introduction
Deep learning
Segmentation
Detection
Lesion classification
Risk prediction
Treatment response
Molecular subtypes
Nodal status
Pathologic complete response
Considerations
Conclusions
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Back Cover