A Novel MRI Method for Breast Cancer Detection Based on Diffusion Tensor Tracking of the Ductal Trees
Erez Eyal¹, Myra Shapiro-Feinberg², Edna Furman Haran¹, Dov Grobgeld¹, Talia Golan³, Yaakov Itzchak³, Raphael Catane³, Moshe Papa⁴, Hadassa Degani^1
1Weizmann Institute of Science, Rehovot, Israel; ²Meir Medical Center, Kfar Saba, Israel; ³Sheba Medical Center, Tel Hashomer, Israel; ⁴Sheba Medical Center, Tel Hashomer, Israel

Mammary malignancies typically develop from the ductal epithelial cells, and spread within the ducts. Consequently, the ductal structures are an important area of investigation of both normal breast development and malignant breast transformation. Our goal is to characterize the anisotropic water diffusion properties in the mammary ductal trees tissue using diffusion tensor MRI and to utilize this method to detect breast cancer. The results show that DTI based MRI reveals the diffusion anisotropy in the mammary ducts and can track changes in the diffusion tensor components due to cancer growth.

Gadofosveset as a Negative Contrast Agent for Detecting Metastatic Axillary Lymph Nodes in Breast Cancer Patients on Diffusion and T2* Weighted Images - A Proof of Principle - not available
Mies A. Korteweg¹, Fredy Visser^1,2, Daniel L. Polders¹, Taro Takahara¹, Willem P.Th.M. Mali¹, Wouter B. Veldhuis^1
1Radiology, University Medical Center Utrecht, Utrecht, Netherlands; ²Philips Healthcare, Best, Netherlands

This abstract describes the pathology-controlled, retrospective, gadofosveset-enhanced 3T MRI characterization of axillary lymph nodes in breast cancer patients. Gadofosveset was hypothesized to accumulate in a higher concentration in healthy than in metastatic nodes. It was shown that the mean absolute T2* relaxation time and the post contrast signal intensity of the lesion to spinal cord ratio on diffusion-weighted (DWI) scans were significantly higher in metastatic compared to non-metastatic nodes. The preliminary results suggest that gadofosveset increased the transverse relaxation rate in healthy nodes causing a negative contrast effect on DWI scans, selectively preserving the signal of metastatic lymph nodes.

Vascular and Cellular Biomarkers from Intravoxel Incoherent Motion (IVIM) MRI in Locally Advanced Breast Cancer Lesions
Eric Edward Sigmund¹, Linda Moy¹, Gene Cho¹, Sungheon Kim¹, Myra Finn¹, Jens Hesselberg Jensen¹, Melanie Moccaldi¹, Daniel Sodickson¹, Robert Schneider², Silvia Formenti^3
1Radiology, New York University Langone Medical Center, New York, NY, United States; ²Microbiology, New York University Langone Medical Center, New York, NY, United States; ³Radiation Oncology, New York University Langone Medical Center, New York, NY, United States

Diffusion-weighted imaging (DWI) is playing an increasing important role in breast cancer lesion characterization, most commonly marking restricted diffusion in tumor cellularity.  Intravoxel incoherent motion (IVIM) MRI is a DWI variant ideally providing markers not only of cellularity, but also tumor vascularity and blood velocity.  In this study we acquired IVIM data in N=25 breast cancer patients at 3 T and compared these markers with contrast-enhanced MRI and biopsy diagnosis.  Robust quantification of the IVIM parameter set clearly differentiated lesions from the weakly perfused normal fibroglandular tissue and may be helpful for future quantitative lesion grading.

Identifying Breast Calcification by Using Susceptibility Weighted Imaging: Optimizing Parameters for Detection of Calcifications at 3T
Ali Fatemi¹, Colm Boylan^2,3, Michael D. Noseworthy^1,4
1Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario, Canada; ²Diagnostic Imaging, St. Joseph's Healthcare, Hamilton, Ontario, Canada; ³Radiology, McMaster University, Hamilton, Ontario, Canada; ⁴Electrical and Computer Engineering, School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada

We have optimized corrected phase images acquired at 3T with a dedicated breast coil to detect breast microcalcification.  Corrected phase images demonstrating calcifications correlate well with x-ray mammography.

High Resolution T2 Breast Imaging Using FADE
Kristin L. Granlund^1,2, Ernesto Staroswiecki^1,2, Marcus T. Alley¹, Bruce L. Daniel¹, Brian A. Hargreaves^1
1Radiology, Stanford University, Stanford, CA, United States; ²Electrical Engineering, Stanford University, Stanford, CA, United States

High resolution breast MRI is useful for distinguishing benign and malignant tumors.  The FADE sequence allows us to acquire two images during a single scan with different image contrasts, the first image having high SNR and the second image having T2 weighting.  A second pair of images can then be acquired with different crusher areas to evaluate the diffusivity of different tissues.  Phantom studies were performed to confirm sources of image contrast.  The technique was then evaluated in two patients and it was found that the FADE sequence highlighted tumors with both high T2 and restricted diffusion.

Time Intensity Curve Analysis of Malignant Enhancing Breast Lesions:  Atypical Findings More Frequent in Smaller Lesions
Dorothee Barbara Engel¹, Winifred Dunbar², Fred Kelcz^2
1Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany; ²Radiology, School of Medicine and Public Health, Madison, WI, United States

Dynamic contrast-enhanced (DCE) breast MRI has become the mainstay for assessing breast problems not resolved by mammography and ultrasound.  A signal intensity vs. time curve showing rapid gadolinium contrast uptake and delayed washout is typically associated with malignancy, but our study of 81 malignant spanning a wide size range showed that the “typical pattern” was only in lesions > 1 cm.  A delayed persistent pattern may be seen in up to 20% of sub-centimeter lesions.  Radiologists should be aware of these exceptions and emphasize morphology over contrast enhancement for small lesions.

Approaching Complete Separation of Benign and Malignant Breast Lesions by DCE-MRI: Impact on Healthcare Costs
Wei Huang¹, Patricia A. Carney¹, Luminita Alina Tudorica¹, Yiyi Chen¹, Xin Li¹, Elizabeth A. Morris², Ian J. Tagge¹, Sunitha Thakur², Maayan Korenblit², Jason A. Koutcher², Charles S. Springer^1
1Oregon Health & Science University, Portland, OR, United States; ²Memorial Sloan Kettering Cancer Center, New York, NY, United States

Shutter-Speed Model (SSM) analyses of breast DCE-MRI data from 98 suspicious lesions show significantly improved diagnostic accuracy compared to Standard Model (SM) analyses and clinical MRI protocols.  The difference in Ktrans derived from the two models, ¦¤Ktrans [¡Ô Ktrans(SSM) ¨C Ktrans(SM)], has near perfect specificity at 100% sensitivity.  The cost effectiveness of replacing unnecessary benign biopsies with SSM DCE-MRI is significant.

Can Proton MR Spectroscopy Provide Useful Information for Characterizing Estrogen Receptor Status in Breast Cancer?
Hyeon-Man Baek¹, Jeon-Hor Chen^2,3, Orhan Nalcioglu², Min-Ying Su^2
1Radiology, UT Southwestern Medical Center, Dallas, TX, United States; ²Center for Function Onco-Imaging, University of California-Irvine, Irvine, CA, United States; ³Radiology, China Medical University Hospital, Taichung, Taiwan

ER-negative cancer was more aggressive, with bigger tumor size, more prominent tumor infiltration showing non-mass-type enhancements on magnetic resonance imaging (MRI) features. The aim of our study was to determine whether in vivo 1H-MRS can provide useful information for characterizing ER status in breast cancer. On the basis of the criterion (i.e., CRB < 100%), tCho detection rate was higher in ER-negative group (16/20, 80%) than in ER-positive group (15/27, 56%), but not reaching significant level (P = 0.083). The ER-positive group had a lower mean tCho concentration than the ER-negative group, but no significant difference was observed (2.01 vs. 2.24 mmol/kg, P = 0.677). The reason why our finding was not significant might be due to the heterogeneity of the breast cancer tissue.

Predicting Long Term Survival for Breast Cancer Patients by HR MAS Metabolic Profiling During Neoadjuvant Chemotherapy
Maria Dung Cao¹, Beathe Sitter¹, Tone Frost Bathen¹, Per Eystein Lønning^2,3, Steinar Lundgren^1,4, Ingrid Susanne Gribbestad^1
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; ²Department of Oncology, Haukeland University Hospital, Bergen, Norway; ³University of Bergen, Bergen, Norway; ⁴Department of Oncology, St.Olav University Hospital, Trondheim, Norway

HR MAS MR metabolic profiling was performed in paired samples from locally advanced breast cancer patients obtained pre (n=19) and post (n=19) doxorubicine treatment.  PLSDA analysis of HR MAS spectra showed classification between patients with long time survival (≥5 years), and patients who died of cancer recurrence within 5 years. Our results suggest distinct metabolic profiles of these two patient groups. High tCho, most significant GPC, levels before treatment correlated to long time survival, while high glycine and lactate levels were associated with poorer outcome.

MRI Characterization of Dissected Sentinel Lymph Nodes of Breast Cancer Patients at 7T - not available
Mies A. Korteweg¹, Jaco J.M. Zwanenburg¹, Vincent O. Boer¹, Richard van Hillegersberg², Paul J. van Diest³, Peter R. Luijten¹, Willem P.Th.M. Mali¹, Wouter B. Veldhuis^1
1Radiology, University Medical Center Utrecht, Utrecht, Netherlands; ²Surgery, University Medical Center Utrecht, Utrecht, Netherlands; ³Pathology, University Medical Center Utrecht, Utrecht, Netherlands

We describe the pathology-correlated 7T MRI characterization of dissected sentinel lymph nodes of breast cancer patients. The mean absolute ADC and T1, T2, T2* relaxation times were determined. Nodal dimensions and the presence of a fatty hilus was scored. In 20 patients 83 nodes were excised and scanned, 17 contained metastases. Blood- and lymph vessels and an in-transit metastasis inside a lymph vessel were identified on MRI. While the location of intranodal metastases could not be delineated morphologically, there was a significant difference in T2 and T2* relaxation times between metastatic and non-metastatic nodes.