Characteristics of Probably Benign Breast MRI Lesions

Characteristics of Probably Benign Breast MRI Lesions
Peter R. Eby, Wendy B. DeMartini, Robert L. Gutierrez, Monica H. Saini, Sue Peacock, and Constance D. Lehman
AJR 2009;193:861-867

Indeterminate lesions on high risk screening MRI are the bane of the radiologists life. Some insurance carriers will not pay for 6 month MRI follow up scans of probably benign lesions, so a review and recommendations for management by Connie Lehman and her group in Washington is very welcome.

The characteristics of BI-RADS 3 lesions were highly variable in our population, and the risk of malignancy was low (0.85%).

Assigning foci with 100% persistent enhancement to the BI-RADS 2 category can decrease the frequency of BI-RADS 3 assessment and maintain a likelihood of malignancy in less than 2% of cases

Mammary Fibromatosis

Mammary Fibromatosis
Katrina N. Glazebrook and Carol A. Reynolds
AJR 2009;193:856-860
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Mammary fibromatosis is a rare, benign, non-metastasizing stromal tumor. It presents clinically and radiologically as a palpable, spiculated, and locally invasive tumor that is suspicious for malignancy. MRI is ideal for evaluation of chest wall involvement. Although histologically benign, the tumor is locally aggressive and has significant recurrence rates. On occasion, recurrence may require radical surgery

MRI Follow-Up After Concordant, Histologically Benign Diagnosis of Breast Lesions Sampled by MRI-Guided Biopsy

MRI Follow-Up After Concordant, Histologically Benign Diagnosis of Breast Lesions Sampled by MRI-Guided Biopsy
Jie Li, D. David Dershaw, Carol H. Lee, Jennifer Kaplan, and Elizabeth A. Morris
AJR 2009;193:850-855

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This paper pertains to benign findings at MRI Biopsy when there is disconcordance with imaging findings
Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling

1H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy?

1H MR Spectroscopy and Diffusion-Weighted Imaging of the Breast: Are They Useful Tools for Characterizing Breast Lesions Before Biopsy?
Mitsuhiro Tozaki and Eisuke Fukuma
AJR 2009;193:840-849
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The results of an in-vivo study using a 1.5-T MRI unit suggested that careful referencing and optimizing post-acquisition data processing improved the spectral resolution, allowing the few false-positive cases (including lactating women and healthy volunteers) to be distinguished by resonance at 3.28 ppm

1H MRS was useful for characterizing breast lesions measuring 15 mm or larger, and diffusion-weighted imaging was useful for characterizing lesions of any size. However, these two techniques still have potential pitfalls in relation to the diagnosis of non-mass breast lesions

Kinetic Curves of Malignant Lesions Are Not Consistent Across MRI Systems

Kinetic Curves of Malignant Lesions Are Not Consistent Across MRI Systems: Need for Improved Standardization of Breast Dynamic Contrast-Enhanced MRI Acquisition
Sanaz A. Jansen, Akiko Shimauchi, Lindsay Zak, Xiaobing Fan, Abbie M. Wood, Gregory S. Karczmar, and Gillian M. Newstead
AJR 2009;193:832-839
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This paper from Chicago demonstrates that the kinetic curve data on malignant lesions acquired with one system showed significantly lower initial contrast uptake and a different curve shape in comparison with data acquired with the other two systems. Differences in k-space sampling, T1 weighting, and magnetization transfer effects may be explanations for the difference.

Standardization of DCE-MRI is needed for direct comparison

MRI-Detected Suspicious Breast Lesions: Predictive Values of Kinetic Features Measured by Computer-Aided Evaluation

MRI-Detected Suspicious Breast Lesions: Predictive Values of Kinetic Features Measured by Computer-Aided Evaluation
Lilian C. Wang, Wendy B. DeMartini, Savannah C. Partridge, Sue Peacock, and Constance D. Lehman
AJR 2009;193:826-831

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Of Computer Aided Enhancement (CAE) kinetics analyzed, only delayed enhancement categorized by most suspicious type was significantly different between benign and malignant lesions. This supports the American College of Radiology BI-RADS Breast MRI Lexicon recommendation to report the "worst looking" kinetic curve