ISMRM 21st Annual Meeting & Exhibition 20-26 April 2013 Salt Lake City, Utah, USA

Breast MRI: Clinical & Technical
Tuesday 23 April 2013
Room 151 AG  10:00 - 12:00 Moderators: Fiona J. Gilbert, Linda Moy

10:00 0194.   
Effect of Risk-Reducing Salpingo-Oophorectomy on Breast MRI Fibroglandular Tissue and Background Parenchymal Enhancement in BRCA1/2 Mutation Carriers: A Quantitative Assessment
Shandong Wu1, Susan M. Domchek2, Michael J. DeLeo, III3, Emily F. Conant3, Susan P. Weinstein3, and Despina Kontos1
1Radiology, University of Pennsylvania, Philadelphia, PA, United States, 2Medicine, University of Pennsylvania, Philadelphia, PA, United States, 3Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States

The purpose of this study is to perform an accurate and robust quantitative assessment to measure the effect of risk-reducing salpingo-oophorectomy (RRSO) on breast MRI fibroglandular tissue volume (FGT) and background parenchymal enhancement (BPE) in BRCA1/2 mutation carriers. The study was conducted using a fully automated breast MRI image segmentation method for quantitative FGT and BPE estimation. Our results show that quantitative rates of BPE-related measures are different before and after RRSO, while FGT-related measures are not. The BPE-related measures could potentially be used as imaging biomarkers to assess response to RRSO as a risk reduction intervention.

10:12 0195.   Parenchymal Enhancement in the Contralateral Normal Breast of Patients Undergoing Neoadjuvant Chemotherapy Measured by DCE-MRI
Jeon-Hor Chen1,2, Hon J. Yu1, Christine Hsu1, Muqing Lin1, Rita S. Mehta3, and Min-Ying Su1
1Center for Functional Onco-Imaging,Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States, 2Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan, 3Department of Medicine, University of California Irvine, Irvine, CA, United States

In this study we measured the background tissue enhancement from the segmented fibroglandular tissue. We found a weak correlation between the percent density and the BPE, suggesting that although they were associated but not highly correlated. Women of younger age tended to have higher BPE than older women. Also, younger women were more likely to show decreased BPE after chemotherapy. The effect of BPE reduction in younger women was most likely due to the ovarian ablation induced by chemotherapeutic agents, thus it may be used as a risk predictor for development of contralateral breast cancer.

10:24 0196.   
Diffusion Weighted Imaging of the Breast at 7T Ready for Clinical Application?
Olgica Zaric1, Katja Pinker2, Stephan Gruber1, David Porter3, Thomas Helbich2, Siegfried Trattnig1, and Wolfgang Bogner1,4
1MR Centre of Excellence, Department of Radiology, Medical University of Vienna, Wien, Wien, Austria, 2Department of Radiology, Medical University of Vienna, Wien, Wien, Austria, 3MR PLM AW Neurology, Siemens Healthcare, Erlangen, Germany, Germany, 4Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

This work presents the first clinical evidence that reproducible high-quality diffusion weighted imaging (DWI) of the breast can be performed at 7T in a large patient population. DWI with sub-millimeter in-plane resolution was obtained in 31 consecutive patients with histopathologically verified breast lesions. A significant reduction of imaging artifacts (i.e., geometric distortions, image blurring by a factor of 6.9) was achieved by combining readout-segmented echo planar imaging, parallel imaging, and additional B1-insensitive fat suppression. DWI of the breast, performed at 7T, with submillimeter inplane resolution provided exceptional image quality leading to excellent differentiation of benign and malignant breast lesions.

10:36 0197.   Simultaneous Diffusion MRI and PET Imaging of Breast Cancer Patients
Eric E. Sigmund1, Sungheon Kim1, Christian Geppert2, Linda Moy3, David Faul2, Christopher B. Glielmi2, Kimberly Jackson3, Kamil Bani-baker3, and Amy Melsaether3
1Radiology, NYU Langone Medical Center, Bernard and Irene Schwartz Center for Biomedical Imaging, New York, NY, United States, 2Siemens Medical Systems, New York, NY, United States, 3Radiology, NYU Langone Medical Center, New York, NY, United States

Diffusion-weighted MRI and fluorodeoxyglucose positron emission tomography (FDG-PET) have diagnostic and prognostic utility in breast cancer imaging, but their inter-correlation and different specificities remain to be established. We employed simultaneous MR/PET, after PET/CT without additional FDG injection, in a cohort of 3 breast cancer patients with a dedicated breast coil. Results were collected for diffusion-weighted imaging, post-Gd contrast imaging, and PET. Intravoxel incoherent motion (IVIM) analysis allowed quantification of tissue diffusivity and perfusion fraction in cancerous lesions, fibroglandular tissue, and other entities. Preliminary results confirm typical trends of malignancy but also suggest the enhanced specificity of the multiparametric MR/PET exam.

10:48 0198.   Compartmental Diffusion in Breast Cancer
Edna Furman-Haran1, Myra Feinberg-Shapiro2, Erez Eyal1, Dov Grobgeld1, Noemi Weisenberg2, Noam Nissan1, Tania Zehavi2, and Hadassa Degani3
1The Weizmann Institute of Science, Rehovot, Israel, 2Meir Medical Center, Kfar Saba, Israel, 3Weizmann Institue of Science, Rehovot, Israel

Diffusion weighted imaging utilizing a broad range of diffusion gradient strengths and diffusion tensor imaging were applied in order to characterize the microstructure of the breast and the compartmentation of breast cancer to extracellular and intracellular environments. Pixel-by-pixel analysis yielded parametric maps of the tensor diffusion parameters and of estimated diffusion coefficients in each compartment. The results indicated that maps of the parameters that characterize water diffusion in the breast facilitate the detection and diagnosis of breast cancer and reveal distinct cellular features

11:00 0199.   Reproducibility of Chemical Exchange Saturation Transfer (CEST) MRI of the Breast at 7 Tesla
Adrienne N. Dula1,2, Lori R. Arlinghaus2, Jason M. Williams2, Richard G. Abramson1,2, Richard D. Dortch1,2, Seth A. Smith1,2, and Thomas E. Yankeelov1,2
1Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, United States, 2Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States

From detection and diagnosis through treatment planning and monitoring, medical imaging plays a vital role in clinical course of breast cancer. Clinical decisions are based on imaging metrics that are typically poor surrogates for underlying tissue pathophysiology. We propose the use of chemical exchange saturation transfer (CEST) imaging to evaluate the biochemical composition of the fibroglandular tissue of the breast. Ten healthy female volunteers were scanned with four returning for repeatability measures. In this study, we have established the reproducibility of the CEST-derived metrics of APT and GAG imaging of the healthy breast at 7T.

11:12 0200.   
Separation of Benign and Malignant Breast Lesions Using Pharmacokinetic Analysis for a Biopsy Cohort
Melanie Freed1, Ana Paula Klautau Leite1,2, Jin Zhang1, Melanie Moccaldi3, Kai Tobias Block4, Linda Moy3, and Sungheon Kim1
1Radiology, Center for Biomedical Imaging, New York University School of Medicine, New York, NY, United States, 2Radiology, Hosptial das Clinicas-FMUSP, School of Medicine - University of Sao Paolo, Sao Paolo, SP, Brazil, 3Radiology, Cancer Institute, New York University School of Medicine, New York, NY, United States,4Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, NY, United States

Although DCE-MRI is an important tool for high-risk screening of breast cancer lesions, its suboptimal specificity results in many unnecessary biopsies. In this study, we investigate the use of pharmacokinetic analysis for discrimination of lesion types in a population of patients referred for biopsy. This population is particularly problematic since standard clinical analysis has already failed for this group. Our analysis shows that Ktrans and ve show noticeable differences between lesion types in this patient group, however, refinement of the analysis methods is necessary to further improve the separation of lesion types for this challenging cohort.

11:24 0201.   Impact of Factors Affecting the Accuracy of Breast MRI in Determining Residual Tumor Size Following Neoadjuvant Chemotherapy -permission withheld
Jeon-Hor Chen1,2, Shadfar Bahri1, Rita S. Mehta3, Philip M. Carpenter4, Christine E. Mclaren5, Wen-Pin Chen6, David J. B. Hsiang7, and Min-Ying Su1
1Center for Functional Onco-Imaging,Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States, 2Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan, 3Department of Medicine, University of California Irvine, Irvine, CA, United States, 4Department of Pathology, University of California Irvine, Irvine, CA, United States, 5Department of Epidemiology, University of California Irvine, Irvine, CA, United States, 6Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, United States, 7Department of Surgery, University of California Irvine, Irvine, CA, United States

This study was to investigate the role of multiple factors, including tumor characteristics, NAC regimens, MR systems, and time to operation, in affecting the accuracy of MRI evaluation of residual tumor size following NAC treatment. A total of 98 patients were studied. Univariate analysis revealed significant predictors including tumor type, morphology, ER, and MR scanner. Multivariate regression analyses demonstrated that only tumor type, tumor morphology, ER status, and HER-2 were independent predictors (all p<0.05). MRI diagnosis is less accurate in cancers with lobular component, cancers presenting non-mass-like enhancements, and cancers with ER positive and HER-2 negative status.

11:36 0202.   Comparison of a High Spatial Resolution DTI Sequence to Standard DTI for Evaluating Fractional Anisotropy of Breast Tumors -permission withheld
Lisa J. Wilmes1, Cheng-Liang Liu1, David C. Newitt1, Suchandrima Banerjee2, Rebekah L. McLaughlin1, Evelyn Proctor1, Emine U. Saritas3, Ajit Shankaranarayanan2, and Nola M. Hylton1
1University of California San Francisco, San Francisco, CA, United States, 2GE Healthcare, Menlo Park, CA, United States, 3University of California Berkeley, Berkeley, CA, United States

A high-resolution diffusion tensor imaging sequence (HR-DTI), was compared to a standard FOV DTI sequence (std-DTI), for evaluating tumor and normal-appearing fibroglandular tissue in ten patients with invasive breast cancer. The apparent diffusion coefficients (ADCs) of tumor and normal breast tissue were significantly different for both HR-DTI (p<0.05) and STD-DTI (p<0.05). A significant difference in the fractional anisotropy (FA) between tumor and normal-appearing fibroglandular tissue was found for HR-DTI (p<0.05) but not for STD-DTI. These preliminary results suggest that high resolution FA may provide improved discrimination between tumor and normal breast tissue compared to standard resolution FA.

11:48 0203.   Manganese-Enhanced MRI for Early Detection of Breast Cancer Metastatic Potential
Joris Tchouala Nofiele1,2, Gregory J. Czarnota2,3, and Hai-Ling Margaret Cheng1,2
1The Hospital for Sick Children, Toronto, Ontario, Canada, 2Medical Biophysics, University of Toronto, Toronto, Ontario, Canada, 3Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Early detection of metastatic potential is a crucial step in the treatment of breast cancer. Determining the aggressiveness and potential of breast cancer to metastasize is critical to selecting the most appropriate treatment before the cancer has spread. This study proposes that the metastatic potential of breast cancer cells can be determined based on cellular uptake of manganese. In-vitro quantitative MRI and elemental analysis show that very metastatic (e.g. MDA-MB-231) and less aggressive (e.g. MCF7) cancer cells are clearly distinguished. This new cellular imaging technique provides a much needed non-invasive capability for early determination of tumor cell aggressiveness.