Characterization of carotid artery plaque components on magnetic resonance imaging using signal intensity of the phantom as a reference.

RATIONALE AND OBJECTIVES: To evaluate the properties of plaque by the use of magnetic resonance imaging (MRI), it is necessary to use a material with stable signal intensity (eg, muscle or submandibular gland) as a reference. However, there may be differences between individuals. Therefore, we used a small phantom set on the circumference of the neck as a reference. The signal intensity ratio (SIR) methods using the phantom as a reference were reviewed for discrimination of the properties of plaque in the carotid artery. MATERIALS AND METHODS: Three phantoms (phantom 1: water; phantom 2: 5 µmol gadopentetate dimeglumine; and phantom 3: 2.5 µmol gadopentetate dimeglumine) were set around the neck. SIR was calculated for each region of interest and compared according to pathological grade. RESULTS: The method using a phantom as a reference reduced the standard deviations of tissue ratios to 0.16 from 0.27 in comparison with the method using muscle and showed a close correlation with pathological grade. In addition, the agreement rates with pathological grade and grades from each SIR using signal intensity of the phantom as a reference were higher than using signal intensity of the muscle as a reference to 0.86 from 0.63 for two-dimensional images and to 0.86 from 0.71 for three-dimensional images. CONCLUSIONS: The method described here reduced error compared to the method using muscle as a reference, and the results were closely correlated with pathological grade.

A comparison of shimming techniques for optimizing fat suppression in MR mammography.

We evaluated the degree of inhomogeneities of fat suppression using the fully automated three-dimensional breast shimming technique (Image Based-Smart: IB-Smart) and manual setting of a rectangular parallelepiped shim (volume shimming) in MR mammography. Information on breast shape was collected from 9 patients whose images were insufficiently fat-suppressed. A breast phantom made of a thermoplastic sheet was used. Shimming of the magnetic field was done with IB-Smart and various dimensions of volume shims: the anterior to posterior/right to left/head to foot directions were set to 75-150/150-350/50-150 mm. The volumes of inhomogeneously suppressed fat were measured. The calculated volume with inhomogeneous fat suppression with use of IB-Smart was 13.3 × 10(4) mm(3). The smallest volume of inhomogeneous fat suppression with volume shimming was 5.4 × 10(4) mm(3) when the anterior-posterior/right-left/head-foot directions were set to 75/350/50 mm. Our results show that using optimized dimensions of volume shims enables better fat suppression than does IB-Smart.

Sonographic and pathologic image analysis of pure mucinous carcinoma of the breast.

The aims of this study were to elucidate sonographic and histologic features of pure mucinous carcinoma (P-MC) of the breast using quantitative analysis and to evaluate the relationship between quantitative analysis and visual qualitative assessment. Eleven P-MCs (nine patients) were evaluated qualitatively and quantitatively. Three experts assessed these sonographic images using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. For assessment of internal echoes and posterior echoes, quantitative measures were determined using ImageJ software. Histologic thin sections were stained for classification into separate parts of the tumor (stroma, mucin and cancer cells) and were digitized. Internal echoes were isoechoic in 7 of 11 (63.6%) tumors and hypoechoic in 4 of 11 (36.4%); all P-MCs were "enhanced" in qualitative evaluation. As internal echoes increased, the proportion of stroma increased and that of mucin decreased. The high level of internal echoes is correlated with reflection and back-scattering, which are caused mainly by the interface between mucin and stroma.

Effect of the menstrual cycle on background parenchymal enhancement in breast MR imaging.

PURPOSE: We assessed the influence of the menstrual cycle on background parenchymal enhancement (BPE) of the breast in the early and delayed phases of dynamic magnetic resonance (MR) imaging and the optimal timing of MR imaging of the breast in Japanese women. MATERIAL AND METHODS: We reviewed dynamic MR images of 165 consecutive women with regular menstrual cycles and divided the women into 4 groups by week of the menstrual cycle: 32 in Week One (Days 1 through 4 of the menstrual cycle); 46 in Week 2 (Days 5 through 12); 49 in Week 3 (Days 13 through 20); and 38 in Week 4 (Days 21 through 30). We qualitatively evaluated BPE of the whole breast in the early and delayed phases of MR imaging; categorized enhancement as minimal, mild, moderate, or marked; and calculated the rate at which signal intensity increased (=SI post-SI pre/SI pre) in regions of interest in from the early and delayed phase to the before contrast administration phase to assess BPE quantitatively. RESULTS: In both the early and delayed dynamic MR phases, BPE was significantly more extensive and stronger in Week 4 than Week 2 (P<0.01). Throughout the menstrual cycle, BPE was significantly stronger in the delayed phase than in the early phase in both qualitative (Week One, P=0.0002; Weeks 2 through 4, P<0.0001) and quantitative (Weeks One through 4, P<0.0001) assessments. CONCLUSION: The optimal time to perform dynamic breast MR imaging in premenopausal Japanese women was during Days 5 through 12 of the menstrual cycle.

The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy.

OBJECTIVES: To evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS). METHODS: We retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging. RESULTS: Sixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (P = 0.007) and higher signal intensities (SI) on FS-T2W images (P = 0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (P = 0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions. CONCLUSIONS: Breast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE. KEY POINTS: MR mammography permits more precise lesion assessment including ductal carcinoma in situ A correct diagnosis of occult invasion before treatment is important for clinicians This study showed the potential of MR mammography to diagnose occult invasion Treatment and/or aggressive biopsy can be given with greater confidence MR mammography can lead to more appropriate management of patients.