Clinical evaluation of cylindrical regional suppression in dynamic contrast-enhanced breast MRI: An intra-individual comparison study on image quality and lesion conspicuity.

PURPOSE: To evaluate the effect of a cylindrical regional-suppression technique (CREST) on image quality and lesion conspicuity in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast. METHOD: This was a comparative study of 67 women with 44 lesions who underwent breast DCE-MRI with CREST (CREST-DCE) and had a previous DCE-MRI without CREST (conv-DCE) available. Two radiologists assessed image quality parameters and lesion conspicuity using five-point Likert scales. In an intra-individual comparison, the effects of CREST on image quality (strong degradation to strong improvement) were assessed. Moreover, both radiologists identified the post-contrast phase, which benefited the most from using CREST in direct comparison. The statistical analysis included the Wilcoxon signed-rank test. RESULTS: Cardiac motion-rated artefacts were significantly reduced in CREST-DCE compared to conv-DCE (3.6 ± 1.2 [CREST-DCE] vs 2.1 ± 0.8 [conv-DCE], p < 0.001). At the axilla, the visualisation of anatomical structures (3.9 ± 1.0 vs 2.3 ± 1.2, p < 0.001) and the skin contour (4.3 ± 0.8 vs 3.0 ± 1.1, p < 0.001) were significantly improved in CREST-DCE, whereas ghosting artefacts were significantly less pronounced (3.8 ± 1.1 vs 2.4 ± 1.0, p < 0.001). The parasternal region was similarly assessable using both techniques (4.3 ± 1.1 vs 4.2 ± 1.2, p = 0.47). In direct comparison, CREST-DCE images were classified as "improved" in 54/67 and "equivalent" in 13/67 exams. The effects of CREST were found to be most pronounced in the very early post-contrast phase (32/67). The lesion conspicuity was rated similar for CREST and conv-DCE (4.7 ± 0.7 vs 4.8 ± 0.2, p = 0.18). CONCLUSIONS: CREST appears to be an effective tool to reduce cardiac motion-related artefacts and, therefore, may improve image quality in breast DCE-MRI without impairing lesion conspicuity.

Digital breast tomosynthesis-guided vacuum-assisted biopsy of suspicious calcifications at different sites within one breast: Is biopsy of more than one location needed?

OBJECTIVE: To investigate how often biopsy of two sites of morphologically similar or equally suspicious calcifications within the same breast yield differing histopathologic results, and how this may affect clinical management. MATERIALS AND METHODS: We identified patients with two or more sites of calcifications categorized as Breast Imaging Reporting and Data System (BI-RADS) ≥ 4b within the same breast who underwent digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-guided VAB). We analyzed how often biopsy of two distinct sites yielded the same or differing histopathologic findings. The histopathologic findings were dichotomized into "actionable" and "non-actionable", depending on the respective further management. We then analyzed how often the consecutive management would have been the same or different. RESULTS: Of 206 women undergoing DBT-guided VAB at our institution within 24 months, 21 consecutive patients (54 ± 10.2 years; range: 35-71) underwent DBT-guided VAB of two distinct sites of calcifications. Management of histologic findings was the same (both sites actionable or both sites non-actionable) in 12/21 (57 %), different in the remaining 9/21 patients (43 %). Of the nine patients whose differing histologic findings would have led to different clinical management, 4/9 had a high-risk lesion (atypical ductal hyperplasia n = 3, papilloma with epithelial atypia n = 1) vs benign changes (adenosis n = 4), 2/9 had high-grade DCIS vs benign changes (adenosis n = 1, fat necrosis n = 1), and 3/9 had invasive cancer (luminal A n = 2, luminal B n = 1) with high-grade DCIS vs pure high-grade DCIS. CONCLUSIONS: Multiple sites of calcifications within the same breast, even when morphologically similar or equally suspicious, may represent different histopathologic findings with different clinical management implications. Accordingly, in the presence of suspicious calcifications at multiple distinct sites within the same breast, biopsy of more than one site of calcification should be considered.