J Korean Soc Magn Reson Med.  2013 Jun;17(2):73-82. 10.13104/jksmrm.2013.17.2.73.

A Method to Quantify Breast MRI for Predicting Tumor Invasion in Patients with Preoperative Biopsy- Proven Ductal Carcinoma in Situ (DCIS)

Affiliations
  • 1Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea. rad-ksh@catholic.ac.kr
  • 2Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea.
  • 3Department of General Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 4Department of Radiology, School of Medicine, Ewha Womans University, Seoul, Korea.
  • 5Siemens Corporation, Corporate Research, Seoul, Korea.
  • 6Siemens Ltd., Seoul, Korea.

Abstract

PURPOSE
To determine the quantitative parameters of breast MRI that predict tumor invasion in biopsy-proven DCIS.
MATERIALS AND METHODS
From January 2009 to March 2010, 42 MRI examinations of 41 patients with biopsy-proven DCIS were included. The quantitative parameters, which include the initial percentage enhancement (E1), peak percentage enhancement (E(peak)), time to peak enhancement (TTP), signal enhancement ratio (SER), arterial enhancement fraction (AEF), apparent diffusion coefficient (ADC) value, long diameter and the volume of the lesion, were calculated as parameters that might predict invasion. Univariate and multivariate analyses were used to identify the parameters associated with invasion.
RESULTS
Out of 42 lesions, 23 lesions were confirmed to be invasive ductal carcinoma (IDC) and 19 lesions were confirmed to be pure DCIS. Tumor size (p = 0.003; 6.5 +/- 3.2 cm vs. 3.6 +/- 2.6 cm, respectively) and SER (p = 0.036; 1.1 +/- 0.3 vs. 0.9 +/- 0.3, respectively) showed statistically significant high in IDC. In contrast, E1, Epeak, TTP, ADC, AEF and volume of the lesion were not statistically significant. Tumor size and SER had statistically significant associations with invasion, with an odds ratio of 1.04 and 22.93, respectively.
CONCLUSION
Of quantitative parameters analyzed, SER and the long diameter of the lesion could be specific parameter for predicting invasion in the biopsy-proven DCIS.

Keyword

Magnetic resonance imaging; Carcinoma in situ; Quantitative parameter

MeSH Terms

Breast
Carcinoma in Situ
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Diffusion
Humans
Lymphokines
Magnetic Resonance Imaging
Multivariate Analysis
Odds Ratio
Thymine Nucleotides
Lymphokines
Thymine Nucleotides

Figure

  • Fig. 1 A 68-year-old female patient with a preoperative diagnosis of ductal carcinoma in situ. a. The post-contrast subtraction image showed a segmental distributed,heterogenous enhancing, non-mass like lesion of 2.4-cm in length at the 10 o'clock position of the right breast. b. The most enhanced area of the lesion was selected in the right breast on the post-contrast subtraction image. c. The kinetic curve (red curve) had the following quantitative parameters: initial enhancement percentage: 144.5%, peak enhancement percentage: 223.8%, time to peak enhancement: 241 seconds, and signal enhancementratio: 0.64. d. The MROncoTreat analysis showed a color map of the whole tumor area. The color map showed the various colors of the lesion according to the thearterial enhancement fraction (AEF; the red color means a high AEF). The diameter, volume, mean ADC, and mean AEF were 2.3 cm, 1.7 cm3, 865.0 × 10-6 mm2/s, and 29.1, respectively. The final histopathological examination of the lesion revealed pure ductal carcinoma in situ.

  • Fig. 2 A 55-year-old female patient with a preoperative diagnosis of ductal carcinoma in situ. a. The MIP (maximal intensity projection) image showed a 7.3-cm, segmental distributed, clumped, enhancing, non-mass like lesion at the upper portion (11-3 o'clock) of the left breast. b. The most enhancing area of the lesion was selected in the left breast on the post-contrast subtraction image. c. The kinetic curve (red curve) had the following quantitative parameters: initial enhancement percentage: 84.2%, peak enhancement percentage: 84.2%, time to peak enhancement: 60seconds, and signal enhancementratio: 1.42. d. The MROncoTreat analysis showed the color map of the entire whole tumor area. The diameter, volume, mean ADC, and mean AEF were 7.1 cm, 13 cm3, 1170 × 10-6 mm2/s, and 41.9, respectively. The final histopathological examination of the lesion revealed invasive ductal carcinoma with ductal carcinoma in situ.


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