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Breast MR Imaging during or Soon after Radiation Therapy¹

¹ From the Department of Radiology and Radiation Therapy, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany. From the 1999 RSNA scientific assembly. Received February 27, 2002; revision requested May 17; final revision received April 7, 2003; accepted May 20. Address correspondence to N.M. (e-mail: n.morakkabati@uni-bonn.de).

View larger version (15K): [in a new window]   Figure 1. Bar graph demonstrates pTN stages of the patients’ primary tumors for which they received radiation therapy. DCIS = ductal carcinoma in situ.

View larger version (18K): [in a new window]   Figure 2. Bar graph demonstrates the prevalence of parenchymal (gray bars) and skin (white bars) edema in patients who were at that time undergoing radiation therapy (RT) (Group A) and who had undergone radiation therapy up to 3 months (Group B), 3-6 months (Group C), and 6-12 months (Group D) earlier.

View larger version (20K): [in a new window]   Figure 3. Bar graph demonstrates the mean enhancement rates of breast parenchyma in patients with irradiated (gray bars) and nonirradiated (white bars) breasts. RT = radiation therapy.

View larger version (83K): [in a new window]   Figure 4a. (a-c) Transverse MR images of the dynamic series obtained in a 54-year-old patient 2 months after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0. (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show that enhancement of breast parenchyma in the irradiated breast (straight arrow) is only slightly increased compared with that in nonirradiated breast. Detection of a focal contrast-enhancing lesion (curved arrow) in the irradiated breast was not impaired. Note the focal mass with oval shape and smooth borders, internal septa, and continuous and progressive signal intensity increase (type 1 signal intensity time course). The lesion was classified as benign (fibroadenoma, BI-RADS category 2) and confirmed with mammographic and breast MR imaging follow-up at 28 months. (d) Graph depicts continuous enhancement (mean enhancement rate of 69% at the first minute); smooth borders helped classify the lesion as probably benign.

View larger version (82K): [in a new window]   Figure 4b. (a-c) Transverse MR images of the dynamic series obtained in a 54-year-old patient 2 months after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0. (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show that enhancement of breast parenchyma in the irradiated breast (straight arrow) is only slightly increased compared with that in nonirradiated breast. Detection of a focal contrast-enhancing lesion (curved arrow) in the irradiated breast was not impaired. Note the focal mass with oval shape and smooth borders, internal septa, and continuous and progressive signal intensity increase (type 1 signal intensity time course). The lesion was classified as benign (fibroadenoma, BI-RADS category 2) and confirmed with mammographic and breast MR imaging follow-up at 28 months. (d) Graph depicts continuous enhancement (mean enhancement rate of 69% at the first minute); smooth borders helped classify the lesion as probably benign.

View larger version (92K): [in a new window]   Figure 4c. (a-c) Transverse MR images of the dynamic series obtained in a 54-year-old patient 2 months after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0. (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show that enhancement of breast parenchyma in the irradiated breast (straight arrow) is only slightly increased compared with that in nonirradiated breast. Detection of a focal contrast-enhancing lesion (curved arrow) in the irradiated breast was not impaired. Note the focal mass with oval shape and smooth borders, internal septa, and continuous and progressive signal intensity increase (type 1 signal intensity time course). The lesion was classified as benign (fibroadenoma, BI-RADS category 2) and confirmed with mammographic and breast MR imaging follow-up at 28 months. (d) Graph depicts continuous enhancement (mean enhancement rate of 69% at the first minute); smooth borders helped classify the lesion as probably benign.

View larger version (15K): [in a new window]   Figure 4d. (a-c) Transverse MR images of the dynamic series obtained in a 54-year-old patient 2 months after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0. (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show that enhancement of breast parenchyma in the irradiated breast (straight arrow) is only slightly increased compared with that in nonirradiated breast. Detection of a focal contrast-enhancing lesion (curved arrow) in the irradiated breast was not impaired. Note the focal mass with oval shape and smooth borders, internal septa, and continuous and progressive signal intensity increase (type 1 signal intensity time course). The lesion was classified as benign (fibroadenoma, BI-RADS category 2) and confirmed with mammographic and breast MR imaging follow-up at 28 months. (d) Graph depicts continuous enhancement (mean enhancement rate of 69% at the first minute); smooth borders helped classify the lesion as probably benign.

View larger version (70K): [in a new window]   Figure 5a. (a-c) Transverse MR images of the dynamic series obtained in a 47-year-old patient after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0 who was at that time undergoing radiation therapy (15th day, after a total dose of 30 Gy). (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show cutaneous edema (straight arrow). Parenchymal enhancement did not differ between treated and nontreated breast. A contrast-enhancing lesion is clearly visible (curved arrow). Note the focal mass with irregular morphology, heterogeneous internal architecture, and strong initial uptake of contrast material with subsequent wash-out. The lesion was prospectively classified as malignant (BI-RADS category 5). MR-guided hook-wire placement (not shown) helped confirm invasive breast cancer. The patient underwent mastectomy. (d) Graph demonstrates that rapid enhancement (mean enhancement rate of 132% at the first minute) and signal intensity wash-out time course were suggestive of invasive breast cancer.

View larger version (74K): [in a new window]   Figure 5b. (a-c) Transverse MR images of the dynamic series obtained in a 47-year-old patient after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0 who was at that time undergoing radiation therapy (15th day, after a total dose of 30 Gy). (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show cutaneous edema (straight arrow). Parenchymal enhancement did not differ between treated and nontreated breast. A contrast-enhancing lesion is clearly visible (curved arrow). Note the focal mass with irregular morphology, heterogeneous internal architecture, and strong initial uptake of contrast material with subsequent wash-out. The lesion was prospectively classified as malignant (BI-RADS category 5). MR-guided hook-wire placement (not shown) helped confirm invasive breast cancer. The patient underwent mastectomy. (d) Graph demonstrates that rapid enhancement (mean enhancement rate of 132% at the first minute) and signal intensity wash-out time course were suggestive of invasive breast cancer.

View larger version (60K): [in a new window]   Figure 5c. (a-c) Transverse MR images of the dynamic series obtained in a 47-year-old patient after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0 who was at that time undergoing radiation therapy (15th day, after a total dose of 30 Gy). (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show cutaneous edema (straight arrow). Parenchymal enhancement did not differ between treated and nontreated breast. A contrast-enhancing lesion is clearly visible (curved arrow). Note the focal mass with irregular morphology, heterogeneous internal architecture, and strong initial uptake of contrast material with subsequent wash-out. The lesion was prospectively classified as malignant (BI-RADS category 5). MR-guided hook-wire placement (not shown) helped confirm invasive breast cancer. The patient underwent mastectomy. (d) Graph demonstrates that rapid enhancement (mean enhancement rate of 132% at the first minute) and signal intensity wash-out time course were suggestive of invasive breast cancer.

View larger version (15K): [in a new window]   Figure 5d. (a-c) Transverse MR images of the dynamic series obtained in a 47-year-old patient after breast-conserving therapy for ductal invasive cancer stage pT1cN0M0 who was at that time undergoing radiation therapy (15th day, after a total dose of 30 Gy). (a) Precontrast and (b) postcontrast T1-weighted gradient-echo (260/4.6, 90° flip angle) and (c) subtracted images show cutaneous edema (straight arrow). Parenchymal enhancement did not differ between treated and nontreated breast. A contrast-enhancing lesion is clearly visible (curved arrow). Note the focal mass with irregular morphology, heterogeneous internal architecture, and strong initial uptake of contrast material with subsequent wash-out. The lesion was prospectively classified as malignant (BI-RADS category 5). MR-guided hook-wire placement (not shown) helped confirm invasive breast cancer. The patient underwent mastectomy. (d) Graph demonstrates that rapid enhancement (mean enhancement rate of 132% at the first minute) and signal intensity wash-out time course were suggestive of invasive breast cancer.