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Dynamic MR Imaging of Breast Lesions: Correlation with Microvessel Distribution Pattern and Histologic Characteristics of Prognosis¹

¹ From the Departments of Radiology (A.T., T.W.V., M.T.), Pathology (O.B., H.A.L.) and Gynaecology (M.S.) and the Institute for Medical Biometry, Epidemiology and Informatics (A.V.), Johannes Gutenberg University of Mainz, Langenbeckstr 1, D-55131 Mainz, Germany. Received February 11, 2005; revision requested April 11; revision received May 30; final version accepted July 1. Supported by a grant from the Deutsche Forschungsgemeinschaft (Th 315/7–1). Address correspondence to A.T. (e-mail: teifke{at}radiologie.klinik.uni-mainz.de).

Purpose: To evaluate the association of dynamic enhancement parameters of benign and malignant breast lesions at magnetic resonance (MR) imaging with microvessel distribution and histologic prognostic tumor characteristics.

Materials and Methods: Regional review board approval and informed consent were obtained. Surgical resection specimens of breast lesions (32 benign, 86 malignant) in 118 patients (age range, 28–86 years; mean, 58 years) who had undergone dynamic T1-weighted MR imaging of both breasts were included in the study. Different MR enhancement parameters and microvessel density (MVD) distribution were determined. In malignant lesions, TNM stage, tumor grade, proliferative activity, and hormone receptor expression were determined. Spearman correlation coefficients; Wilcoxon, Fisher exact, Kruskal Wallis, and ² tests; and logistic regression analysis were used for evaluation.

Results: Malignant lesions exhibited a higher ratio of microvessels in tumor periphery versus tumor center than did benign lesions (P < .0005). High vessel ratios (P = .001) and low central vessel numbers (P = .007) were associated with high tumor grade. In malignant lesions, initial enhancement ratios of periphery to center of lesion correlated with the corresponding microvessel ratios (r = 0.61). Yet, a high peripheral MVD was not associated with strong peripheral enhancement (r = –0.09). High enhancement ratios, washout rates, and early enhancement peaks were associated with unfavorable, albeit not significant, prognostic indicators. Visible rim enhancement was the most accurate prognostic enhancement criterion for estrogen receptor status (P = .007), tumor grade (P = .06), and lymph node status (P = .046). Washout was the best discriminating criterion for proliferative activity.

Conclusion: The different enhancement behaviors of malignant and benign breast lesions cannot be explained by MVD alone; however, a low MVD in the center of carcinoma is reflected quantitatively by a high enhancement ratio and qualitatively by rim enhancement, with an implication of adverse prognosis.

© RSNA, 2006