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Dynamic Bilateral Contrast-enhanced MR Imaging of the Breast: Trade-off between Spatial and Temporal Resolution¹

¹ From the Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany. Received May 4, 2004; revision requested July 19; revision received November 4; accepted December 14. Address correspondence to C.K.K. (e-mail: kuhl{at}uni-bonn.de).

View larger version (81K): [in a new window]   Figure 1a. Transverse postcontrast dynamic subtracted MR images (270/4.6 [repetition time msec/echo time msec] and 90° flip angle) obtained at standard two-dimensional (2D) gradient-echo dynamic MR imaging (temporal resolution, 69 seconds per dynamic acquisition; imaging matrix, 256 x 256) of 53-year-old woman with invasive ductal cancer. Same section is displayed throughout dynamic series at (a) 69 seconds, (b) 2 minutes 18 seconds, (c) 3 minutes 27 seconds, and (d) 4 minutes 36 seconds after contrast material injection. Note that contrast between cancer (arrow) and normal fibroglandular tissue on both sides (arrowheads) is best in early postcontrast phase (a). Owing to strong washout effect in the cancer and progressive increase in signal intensity of normal parenchyma, cancer can be overlooked already on third postcontrast image (c). Assessment of fine morphologic details will not be feasible in these delayed postcontrast images because of lack of contrast between cancer and normal tissue.

View larger version (85K): [in a new window]   Figure 1b. Transverse postcontrast dynamic subtracted MR images (270/4.6 [repetition time msec/echo time msec] and 90° flip angle) obtained at standard two-dimensional (2D) gradient-echo dynamic MR imaging (temporal resolution, 69 seconds per dynamic acquisition; imaging matrix, 256 x 256) of 53-year-old woman with invasive ductal cancer. Same section is displayed throughout dynamic series at (a) 69 seconds, (b) 2 minutes 18 seconds, (c) 3 minutes 27 seconds, and (d) 4 minutes 36 seconds after contrast material injection. Note that contrast between cancer (arrow) and normal fibroglandular tissue on both sides (arrowheads) is best in early postcontrast phase (a). Owing to strong washout effect in the cancer and progressive increase in signal intensity of normal parenchyma, cancer can be overlooked already on third postcontrast image (c). Assessment of fine morphologic details will not be feasible in these delayed postcontrast images because of lack of contrast between cancer and normal tissue.

View larger version (86K): [in a new window]   Figure 1c. Transverse postcontrast dynamic subtracted MR images (270/4.6 [repetition time msec/echo time msec] and 90° flip angle) obtained at standard two-dimensional (2D) gradient-echo dynamic MR imaging (temporal resolution, 69 seconds per dynamic acquisition; imaging matrix, 256 x 256) of 53-year-old woman with invasive ductal cancer. Same section is displayed throughout dynamic series at (a) 69 seconds, (b) 2 minutes 18 seconds, (c) 3 minutes 27 seconds, and (d) 4 minutes 36 seconds after contrast material injection. Note that contrast between cancer (arrow) and normal fibroglandular tissue on both sides (arrowheads) is best in early postcontrast phase (a). Owing to strong washout effect in the cancer and progressive increase in signal intensity of normal parenchyma, cancer can be overlooked already on third postcontrast image (c). Assessment of fine morphologic details will not be feasible in these delayed postcontrast images because of lack of contrast between cancer and normal tissue.

View larger version (90K): [in a new window]   Figure 1d. Transverse postcontrast dynamic subtracted MR images (270/4.6 [repetition time msec/echo time msec] and 90° flip angle) obtained at standard two-dimensional (2D) gradient-echo dynamic MR imaging (temporal resolution, 69 seconds per dynamic acquisition; imaging matrix, 256 x 256) of 53-year-old woman with invasive ductal cancer. Same section is displayed throughout dynamic series at (a) 69 seconds, (b) 2 minutes 18 seconds, (c) 3 minutes 27 seconds, and (d) 4 minutes 36 seconds after contrast material injection. Note that contrast between cancer (arrow) and normal fibroglandular tissue on both sides (arrowheads) is best in early postcontrast phase (a). Owing to strong washout effect in the cancer and progressive increase in signal intensity of normal parenchyma, cancer can be overlooked already on third postcontrast image (c). Assessment of fine morphologic details will not be feasible in these delayed postcontrast images because of lack of contrast between cancer and normal tissue.

View larger version (23K): [in a new window]   Figure 2. Graph demonstrates mean enhancement rates of benign (n = 28) and malignant (n = 26) breast lesions for standard dynamic protocol (SPD) and modified dynamic protocol (MDP). Values are given for first postcontrast dynamic image (ER1) obtained 69 seconds after contrast material injection and second postcontrast dynamic image (ER2) obtained 138 seconds after contrast material injection for standard dynamic protocol and for first postcontrast dynamic image (ER) obtained 116 seconds after contrast material injection for modified dynamic protocol. Respective values of mean enhancement rates are given on bottom of bars. Note that a significant difference in mean enhancement rates between benign and malignant lesions was present only in ER1.

View larger version (16K): [in a new window]   Figure 3. Graph demonstrates distribution of different signal intensity (SI) time course patterns in benign and malignant lesions for standard and modified dynamic protocols. Type 1 corresponds to a time course with a persistent, progressive increase in signal intensity throughout dynamic series, type 2 corresponds to a curve with plateau formation, and type 3 corresponds to a time course with early washout. MDP = modified dynamic protocol, SPD = standard dynamic protocol.

View larger version (135K): [in a new window]   Figure 4a. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (133K): [in a new window]   Figure 4b. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (102K): [in a new window]   Figure 4c. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (14K): [in a new window]   Figure 4d. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (151K): [in a new window]   Figure 4e. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (147K): [in a new window]   Figure 4f. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (146K): [in a new window]   Figure 4g. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (15K): [in a new window]   Figure 4h. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding signal intensity time course graphs for 62-year-old woman with breast cancer who underwent MR imaging for preoperative staging. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), enhancing breast cancer (arrow in a, b, and c) appeared as irregular mass with smooth borders in (a) precontrast image, (b) first postcontrast image, and (c) first subtracted postcontrast image. (d) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 4. (e–g) For modified dynamic protocol (400 x 512 imaging matrix with temporal resolution of 116 seconds), spicules were visualized at site of enhancing breast cancer (arrow in e, f, and g) in (e) precontrast image, (f) first postcontrast image, and (g) first subtracted postcontrast image (note the visible spicules). (h) Graph demonstrates type 3 (washout) signal intensity time course for modified dynamic protocol. Lesion was rated as BI-RADS category 5. Contrast enhancement kinetics were equivalent (strong early enhancement above threshold and plateau time course) for both protocols.

View larger version (129K): [in a new window]   Figure 5a. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (129K): [in a new window]   Figure 5b. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (122K): [in a new window]   Figure 5c. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (15K): [in a new window]   Figure 5d. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (140K): [in a new window]   Figure 5e. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (153K): [in a new window]   Figure 5f. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (157K): [in a new window]   Figure 5g. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (15K): [in a new window]   Figure 5h. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 51-year-old woman with history of cancer in left breast who underwent follow-up MR imaging. Focal mass was present that exhibited oval shape and smooth borders. (a–c) For standard dynamic protocol (256 x 256 imaging matrix with temporal resolution of 69 seconds), internal enhancement seemed homogeneous. Arrow indicates site of lesion in (a) precontrast image, (b) first postcontrast image, and (c) subtraction of first postcontrast image (note the homogeneous internal enhancement of lesion). (d) Graph demonstrates type 1 (persistent enhancement) signal intensity time course of the enhancing lesion for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probably benign), and 6-month follow-up was recommended. (e–g) For modified dynamic protocol (512 x 400 imaging matrix with temporal resolution of 116 seconds), internal low-signal-intensity internal septations became visible. Lesion was categorized as BI-RADS category 2, and findings at long-term follow-up for 36 months confirmed presence of fibroadenoma. Arrow indicates site of lesion in (e) precontrast image, (f) first postcontrast image, and (g) subtraction of first postcontrast image. Note low-signal-intensity internal septations in f and g. (h) Graph demonstrates type 1 (persistent enhancement) signal intensity time course for modified dynamic protocol. Time course was equivalent to that seen in d.

View larger version (87K): [in a new window]   Figure 6a. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 45-year-old woman at high genetic risk for breast cancer who underwent screening with dynamic MR imaging. (a) In first subtracted postcontrast image for standard dynamic protocol, focal contrast-enhancing lesion (arrow) appeared to have round shape and smooth borders. (b) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probable fibroadenoma). (c) In first subtracted postcontrast image for modified dynamic protocol, lesion (arrow) appeared ill defined and irregular. (d) Graph demonstrates type 3 (washout) signal intensity time for modified dynamic protocol. Lesion was rated as BI-RADS category 5. MR-guided excisional biopsy was performed and revealed 6-mm focal high-grade ductal carcinoma in situ.

View larger version (36K): [in a new window]   Figure 6b. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 45-year-old woman at high genetic risk for breast cancer who underwent screening with dynamic MR imaging. (a) In first subtracted postcontrast image for standard dynamic protocol, focal contrast-enhancing lesion (arrow) appeared to have round shape and smooth borders. (b) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probable fibroadenoma). (c) In first subtracted postcontrast image for modified dynamic protocol, lesion (arrow) appeared ill defined and irregular. (d) Graph demonstrates type 3 (washout) signal intensity time for modified dynamic protocol. Lesion was rated as BI-RADS category 5. MR-guided excisional biopsy was performed and revealed 6-mm focal high-grade ductal carcinoma in situ.

View larger version (104K): [in a new window]   Figure 6c. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 45-year-old woman at high genetic risk for breast cancer who underwent screening with dynamic MR imaging. (a) In first subtracted postcontrast image for standard dynamic protocol, focal contrast-enhancing lesion (arrow) appeared to have round shape and smooth borders. (b) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probable fibroadenoma). (c) In first subtracted postcontrast image for modified dynamic protocol, lesion (arrow) appeared ill defined and irregular. (d) Graph demonstrates type 3 (washout) signal intensity time for modified dynamic protocol. Lesion was rated as BI-RADS category 5. MR-guided excisional biopsy was performed and revealed 6-mm focal high-grade ductal carcinoma in situ.

View larger version (18K): [in a new window]   Figure 6d. Transverse T1-weighted gradient-echo MR images (2D gradient-echo sequence, 290/4.6, and 90° flip angle) and corresponding time course graphs for 45-year-old woman at high genetic risk for breast cancer who underwent screening with dynamic MR imaging. (a) In first subtracted postcontrast image for standard dynamic protocol, focal contrast-enhancing lesion (arrow) appeared to have round shape and smooth borders. (b) Graph demonstrates type 2 (plateau) signal intensity time course for standard dynamic protocol. Lesion was rated as BI-RADS category 3 (probable fibroadenoma). (c) In first subtracted postcontrast image for modified dynamic protocol, lesion (arrow) appeared ill defined and irregular. (d) Graph demonstrates type 3 (washout) signal intensity time for modified dynamic protocol. Lesion was rated as BI-RADS category 5. MR-guided excisional biopsy was performed and revealed 6-mm focal high-grade ductal carcinoma in situ.