HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Michel, S. C. A. Articles by Kubik-Huch, R. A. Search for Related Content PubMed PubMed Citation Articles by Michel, S. C. A. Articles by Kubik-Huch, R. A.

Preoperative Breast Cancer Staging: MR Imaging of the Axilla with Ultrasmall Superparamagnetic Iron Oxide Enhancement¹

¹ From the Institute of Diagnostic Radiology (S.C.A.M., T.M.K., B.M., R.A.K.H.), Department of Obstetrics and Gynecology (D.F.), and Department of Pathology (R.C.), University Hospital Zurich, Switzerland; Department of Biostatistics, University of Zurich, Switzerland (B.S.); and Guerbet, Zurich, Switzerland (J.M.F.). From the 2001 RSNA scientific assembly. Received September 28, 2001; revision requested December 10; revision received January 7, 2002; accepted February 26. Supported in part by a grant from the Legat Frau Henriette Rossiez-Treichler, Zurich, Switzerland. Address correspondence to R.A.K.H., Institute of Diagnostic Radiology, Cantonal Hospital, CH-5404 Baden, Switzerland (e-mail: rahel.kubik@ksb.ch).

View larger version (101K): [in a new window]   Figure 1a. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.

View larger version (83K): [in a new window]   Figure 1b. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.

View larger version (100K): [in a new window]   Figure 1c. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.

View larger version (69K): [in a new window]   Figure 1d. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.

View larger version (102K): [in a new window]   Figure 1e. Cytologically confirmed invasive carcinoma in a 37-year-old patient with a palpable lump in the left breast. (a-c) Preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given before surgery. (a) Mediolateral mammographic images of both breasts. Since the breast parenchyma was dense, the tumor could not be delineated. R = right breast, L = left breast. (b) Axial gadolinium-enhanced T1-weighted MR image of the breast (early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at initial presentation showed extensive tumor growth (arrow). (c) Coronal USPIO-enhanced MR images obtained at initial presentation (left: T1-weighted SE 450/8; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) demonstrated multiple axillary nodes (arrows) mostly lacking USPIO enhancement that were subsequently confirmed to be metastatic by means of US-guided fine-needle aspiration biopsy. (d) Axial follow-up MR image obtained after neoadjuvant chemotherapy showed no contrast-enhanced lesion in the breast. (e) Coronal USPIO-enhanced MR images obtained after chemotherapy (left: T1-weighted SE; right: T1-weighted GRE) showed regression of axillary nodes; peripheral rim enhancement (arrows) surrounding the fatty hilum of the node is seen.

View larger version (89K): [in a new window]   Figure 2a. Primary tumor stage pT1pN1G3 in a 37-year-old patient. (a) USPIO-enhanced MR angiographic image (3D fast spoiled GRE time-of-flight 7.7/1.8; flip angle, 45°; maximum intensity projection acquired from all axial planes). (b) Gadolinium-enhanced MR image of the breast (axial early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at the same time as was the image of the axilla. While the tumor in the left breast shows early and strong peripheral enhancement after gadolinium administration (arrow in b), it cannot be delineated on the USPIO-enhanced image. Because of the lengthy presence of the USPIO in the intravascular compartment, vessels within the breast parenchyma are well seen (arrow in a). USPIO administration does not hamper interpretation of gadolinium-enhanced MR images.

View larger version (94K): [in a new window]   Figure 2b. Primary tumor stage pT1pN1G3 in a 37-year-old patient. (a) USPIO-enhanced MR angiographic image (3D fast spoiled GRE time-of-flight 7.7/1.8; flip angle, 45°; maximum intensity projection acquired from all axial planes). (b) Gadolinium-enhanced MR image of the breast (axial early subtraction 3D fast spoiled GRE 7.7/1.8 with a 30° flip angle) obtained at the same time as was the image of the axilla. While the tumor in the left breast shows early and strong peripheral enhancement after gadolinium administration (arrow in b), it cannot be delineated on the USPIO-enhanced image. Because of the lengthy presence of the USPIO in the intravascular compartment, vessels within the breast parenchyma are well seen (arrow in a). USPIO administration does not hamper interpretation of gadolinium-enhanced MR images.

View larger version (48K): [in a new window]   Figure 3a. Primary tumor stage pT1pN1(7/13)G3 in the same 37-year-old patient as in Figure 2. (a) Coronal USPIO-enhanced MR images (left: T1-weighted SE 450/8; middle: fat-saturated T2-weighted fast SE 4,500/36; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) show two round nodes (arrows) with sizes of 2.1 x 1.6 cm (upper node) and 2.0 x 1.5 cm (lower node). The nodes are hypointense on T1-weighted SE images and hyperintense on T2-weighted fast SE images and show only thin peripheral USPIO enhancement. (b) Photomicrograph of a histologic sample of one lymph node metastasis. Arrowheads point to small rims of normal lymphatic tissue. The lymph node is otherwise replaced by metastatic tissue. (Hematoxylin-eosin stain; original magnification, x3.)

View larger version (94K): [in a new window]   Figure 3b. Primary tumor stage pT1pN1(7/13)G3 in the same 37-year-old patient as in Figure 2. (a) Coronal USPIO-enhanced MR images (left: T1-weighted SE 450/8; middle: fat-saturated T2-weighted fast SE 4,500/36; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) show two round nodes (arrows) with sizes of 2.1 x 1.6 cm (upper node) and 2.0 x 1.5 cm (lower node). The nodes are hypointense on T1-weighted SE images and hyperintense on T2-weighted fast SE images and show only thin peripheral USPIO enhancement. (b) Photomicrograph of a histologic sample of one lymph node metastasis. Arrowheads point to small rims of normal lymphatic tissue. The lymph node is otherwise replaced by metastatic tissue. (Hematoxylin-eosin stain; original magnification, x3.)

View larger version (51K): [in a new window]   Figure 4. Primary tumor stage pT2N0G2 in a 61-year-old patient. Coronal USPIO-enhanced MR images (left: T1-weighted SE 450/8; middle: fat-saturated T2-weighted fast SE 4,500/36; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) shows an oval node (arrows) with a size of 2.1 x 1.0 cm. The node has a fatty hilum and demonstrates peripheral USPIO uptake. Because of the susceptibility artifacts of the contrast agent, the node appears to be larger on the GRE image.

View larger version (59K): [in a new window]   Figure 5a. Primary tumor stage pT2N1G3 in a 39-year-old patient. (a) Coronal USPIO-enhanced MR images (left: T1-weighted SE 450/8; middle: fat-saturated T2-weighted fast SE 4,500/36; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) show a round node (arrowheads) with a size of 1.4 x 0.9 cm. The node is hyperintense on the T2-weighted image and shows only a small peripheral rim of USPIO enhancement. It was thus classified as malignant. An adjacent node (arrows) showed heterogeneous but strong USPIO enhancement and was falsely diagnosed as benign. (b) Photomicrograph of a histologic specimen of one metastatic lymph node. Arrowheads indicate small foci of metastatic tissue. Inset shows metastatic focus. (Hematoxylin-eosin stain; original magnification, x12; inset original magnification, x100.)

View larger version (140K): [in a new window]   Figure 5b. Primary tumor stage pT2N1G3 in a 39-year-old patient. (a) Coronal USPIO-enhanced MR images (left: T1-weighted SE 450/8; middle: fat-saturated T2-weighted fast SE 4,500/36; right: T1-weighted fast spoiled GRE 80/8 with a 40° flip angle) show a round node (arrowheads) with a size of 1.4 x 0.9 cm. The node is hyperintense on the T2-weighted image and shows only a small peripheral rim of USPIO enhancement. It was thus classified as malignant. An adjacent node (arrows) showed heterogeneous but strong USPIO enhancement and was falsely diagnosed as benign. (b) Photomicrograph of a histologic specimen of one metastatic lymph node. Arrowheads indicate small foci of metastatic tissue. Inset shows metastatic focus. (Hematoxylin-eosin stain; original magnification, x12; inset original magnification, x100.)

View larger version (104K): [in a new window]   Figure 6. Primary tumor stage pT2N1(1/25)G2 in a 42-year-old patient. Coronal USPIO-enhanced MR images (left: T2-weighted fast SE 4,500/36; right: T1-weighted GRE 120/15 with a 25° flip angle) show an oval node (arrows) with a size of 3.4 x 1.6 cm and lack of USPIO enhancement. The node was correctly classified as malignant. An adjacent small benign node (arrowheads) with homogenous USPIO enhancement is seen.