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Contrast-enhanced MR Mammography for Evaluation of the Contralateral Breast in Patients with Diagnosed Unilateral Breast Cancer or High-Risk Lesions¹

¹ From the Departments of Radiological Sciences (F.P., C.C., A.R., S.P., F.A., E.M., R.P.) and Surgery (A.M.P.), University of Rome "La Sapienza," Viale Regina Elena, 324, 00161 Rome, Italy; and Department of Worldwide Medical Affairs, Bracco Imaging, Milan, Italy (M.A.K.). Received May 13, 2006; revision requested July 13; revision received July 24; accepted August 23; final version accepted October 5. Address correspondence to F.P. (e-mail: federica.pediconi{at}uniroma1.it).

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Flow diagram depicts patient enrollment, diagnostic examinations performed, and major findings. CE-MRM = contrast-enhanced MR mammography.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Multifocal ILC in the upper outer quadrant of the right breast and negative findings in contralateral breast at conventional mammography and US in a 54-year-old woman. (a) Craniocaudal and (b) mediolateral conventional mammograms show presence of three parenchymal distortions (arrows) in the upper outer quadrant of the right breast. (c) Transverse maximum intensity projection reconstruction of contrast-enhanced T1-weighted GRE MR image (8.1/4; flip angle, 30°) shows presence of three suspicious lesions (arrows) suggestive of multifocal lesions in the upper outer quadrant of the right breast. No lesions were evident at contrast-enhanced MR mammography of the contralateral left breast. This finding was confirmed at follow-up conventional mammography, US, and contrast-enhanced MR mammography.

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Multifocal ILC in the upper outer quadrant of the right breast and negative findings in contralateral breast at conventional mammography and US in a 54-year-old woman. (a) Craniocaudal and (b) mediolateral conventional mammograms show presence of three parenchymal distortions (arrows) in the upper outer quadrant of the right breast. (c) Transverse maximum intensity projection reconstruction of contrast-enhanced T1-weighted GRE MR image (8.1/4; flip angle, 30°) shows presence of three suspicious lesions (arrows) suggestive of multifocal lesions in the upper outer quadrant of the right breast. No lesions were evident at contrast-enhanced MR mammography of the contralateral left breast. This finding was confirmed at follow-up conventional mammography, US, and contrast-enhanced MR mammography.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Multifocal ILC in the upper outer quadrant of the right breast and negative findings in contralateral breast at conventional mammography and US in a 54-year-old woman. (a) Craniocaudal and (b) mediolateral conventional mammograms show presence of three parenchymal distortions (arrows) in the upper outer quadrant of the right breast. (c) Transverse maximum intensity projection reconstruction of contrast-enhanced T1-weighted GRE MR image (8.1/4; flip angle, 30°) shows presence of three suspicious lesions (arrows) suggestive of multifocal lesions in the upper outer quadrant of the right breast. No lesions were evident at contrast-enhanced MR mammography of the contralateral left breast. This finding was confirmed at follow-up conventional mammography, US, and contrast-enhanced MR mammography.

View larger version (116K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: ILC in the lower quadrant of the right breast and a DCIS lesion in the contralateral breast in a 39-year-old woman. (a) Craniocaudal conventional mammogram shows presence of a round high-density mass with indistinct margin (arrow) in the middle of the right breast. (b) Transverse contrast-enhanced T1-weighted GRE subtracted MR image (8.1/4; flip angle, 30°) confirms the presence of a suspicious lobulated lesion (arrow) in the lower outer quadrant of the right breast with a type III signal intensity–time curve. (c) Transverse contrast-enhanced GRE subtracted MR image of the contralateral breast reveals additional suspicious lesion (arrow) with a type III signal intensity–time curve.

View larger version (149K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: ILC in the lower quadrant of the right breast and a DCIS lesion in the contralateral breast in a 39-year-old woman. (a) Craniocaudal conventional mammogram shows presence of a round high-density mass with indistinct margin (arrow) in the middle of the right breast. (b) Transverse contrast-enhanced T1-weighted GRE subtracted MR image (8.1/4; flip angle, 30°) confirms the presence of a suspicious lobulated lesion (arrow) in the lower outer quadrant of the right breast with a type III signal intensity–time curve. (c) Transverse contrast-enhanced GRE subtracted MR image of the contralateral breast reveals additional suspicious lesion (arrow) with a type III signal intensity–time curve.

View larger version (139K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: ILC in the lower quadrant of the right breast and a DCIS lesion in the contralateral breast in a 39-year-old woman. (a) Craniocaudal conventional mammogram shows presence of a round high-density mass with indistinct margin (arrow) in the middle of the right breast. (b) Transverse contrast-enhanced T1-weighted GRE subtracted MR image (8.1/4; flip angle, 30°) confirms the presence of a suspicious lobulated lesion (arrow) in the lower outer quadrant of the right breast with a type III signal intensity–time curve. (c) Transverse contrast-enhanced GRE subtracted MR image of the contralateral breast reveals additional suspicious lesion (arrow) with a type III signal intensity–time curve.

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: IDC in the left breast and a fibroadenoma in the right breast in a 74-year-old woman. (a) Mediolateral oblique conventional mammogram reveals parenchymal distortion (arrow) in the upper inner quadrant of the left breast. (b, c) Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm presence of a lesion (arrow) with suspicious morphologic and enhancement characteristics in the upper inner quadrant of the left breast and (c) show presence of another lesion (arrow) in the contralateral right breast, with homogeneous enhancement and type I signal intensity–time curve suggestive of a benign lesion.

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: IDC in the left breast and a fibroadenoma in the right breast in a 74-year-old woman. (a) Mediolateral oblique conventional mammogram reveals parenchymal distortion (arrow) in the upper inner quadrant of the left breast. (b, c) Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm presence of a lesion (arrow) with suspicious morphologic and enhancement characteristics in the upper inner quadrant of the left breast and (c) show presence of another lesion (arrow) in the contralateral right breast, with homogeneous enhancement and type I signal intensity–time curve suggestive of a benign lesion.

View larger version (135K): [in this window] [in a new window] [Download PPT slide]   Figure 4c: IDC in the left breast and a fibroadenoma in the right breast in a 74-year-old woman. (a) Mediolateral oblique conventional mammogram reveals parenchymal distortion (arrow) in the upper inner quadrant of the left breast. (b, c) Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm presence of a lesion (arrow) with suspicious morphologic and enhancement characteristics in the upper inner quadrant of the left breast and (c) show presence of another lesion (arrow) in the contralateral right breast, with homogeneous enhancement and type I signal intensity–time curve suggestive of a benign lesion.

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: DCIS and a benign nodule (fibroadenolipoma) in the left breast and a DCIS lesion in the contralateral right breast in a 46-year-old woman. (a) Mediolateral oblique conventional mammogram reveals a parenchymal distortion (white arrow) and a benign nodule (black arrow) in the upper outer quadrant of the left breast. Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm the presence of the malignant lesion (arrow) in the upper outer quadrant of left breast and (c) reveal the presence of another lesion (arrow) in the contralateral right breast, with morphologic characteristics suggestive of malignancy (DCIS).

View larger version (94K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: DCIS and a benign nodule (fibroadenolipoma) in the left breast and a DCIS lesion in the contralateral right breast in a 46-year-old woman. (a) Mediolateral oblique conventional mammogram reveals a parenchymal distortion (white arrow) and a benign nodule (black arrow) in the upper outer quadrant of the left breast. Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm the presence of the malignant lesion (arrow) in the upper outer quadrant of left breast and (c) reveal the presence of another lesion (arrow) in the contralateral right breast, with morphologic characteristics suggestive of malignancy (DCIS).

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 5c: DCIS and a benign nodule (fibroadenolipoma) in the left breast and a DCIS lesion in the contralateral right breast in a 46-year-old woman. (a) Mediolateral oblique conventional mammogram reveals a parenchymal distortion (white arrow) and a benign nodule (black arrow) in the upper outer quadrant of the left breast. Transverse contrast-enhanced T1-weighted GRE subtracted MR images (8.1/4; flip angle, 30°) (b) confirm the presence of the malignant lesion (arrow) in the upper outer quadrant of left breast and (c) reveal the presence of another lesion (arrow) in the contralateral right breast, with morphologic characteristics suggestive of malignancy (DCIS).