Breast imaging breast mri s taieb

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  • 1. New Breast MR Imaging Sophie Taeb, Luc Ceugnart Anticancer center Oscar Lambret - Lille -
  • 2. Perform in specialist breast units with experience in CI At least 150 MRI / year / centre MRI biopsy in house or agreement with another institution Use adequat sequences in adequat period of menstrual cycle (7-12) Respect indications Use Birads lexicon to describe lesions
  • 3. 35 y-o. BRCa2. Yearly MRI Right Breast : Mass BiRads 5 US: mass 25 mm IDC grade 3 RE+, RP-, Her2 -, Ki67 25-30%
  • 4. Right breast 6h : DCIS Pas de traduction echo- mammographique
  • 5. Right mastectomy IDC 16 mm DCIS 11 mm 1N+ / 13 N MRI allows to highlight carcinoma not seen on mammo or US J
  • 6. 41 y-o - Nurse Normal physical examination Mother with breast carcinoma under 50 years-old 1st mammography
  • 7. US : no lesions seen BiRads 3 or MRI ?
  • 8. BiRads 2
  • 9. MRI = PROBLEM SOLVING J
  • 10. CONTRALATERAL BREAST 3rd sequence postC T2FS Washin card BiRads 3 US : not seen
  • 11. Follow up 4 months : Persistence of lesion Biopsy Failure
  • 12. 2 Months later : SURGERY MRI wire localization HYPERPLASIA without atypical cells MRI = Problem creating L
  • 13. The breast MRI we need Safe : No toxicity (gadolinium-chelates) High Sensitivity, Specificity, PPV, PNV : Even with low prevalence of disease Good reproducibility : Inter et Intra observers Low coast : Money, Medicals and Patients time Easy comparison with gold standards Mammo US Biopsy - Surgery Histopathology
  • 14. The breast MRI we need Safe : No toxicity (gadolinium-chelates) High Sensitivity, Specificity, PPV, PNV : Even with low prevalence of disease Good reproducibility : Inter et Intra observers Low coast : Money, Medicals and Patients time Easy comparison with gold standards Mammo US Biopsy - Surgery Histopathology
  • 15. MRI = Poor specificity 44 studies / 251 : 1985 - 2005 Se : 90% [0.88-0.92] Sp : 72% [0.67-0.77]
  • 16. 11 studies (1994-2007) No randomised studies 2 mutations (727), 9 mutations + risk > 15% for all life (4939) 218 cancers : 3.5% (45) - 2% (171) - 20% DCIS - 60%N+ (126) Se : Mammo 14-59% ; MRI 51-100% Sp : Mammo 91-100% ; MRI 79-98%
  • 17. 50 / 237 1996-2011 10811 women Extension surgery in 12,8% but useless in 6,3% of cases Miss information about overall survival MRI : 20% homolat lesions. PPV of cancer : 59-74% need biopsy PPV : 75% if > 1,5T ; 59% if < 1,5T 5,5% controlat. PPV of cancer : 27-47% need biopsy PPV : 40% if > 1,5T ; 19% if < 1,5T
  • 18. Improve specificity : 3T MRI ? Adequat sequences : 2nd Week of menstrual cycle At least one unenhanced high-contrast sequence (T2 FSE) 2D or 3D T1-w. dynamic seq. : pixel < 1,5 mm2, thickness < 4mm, < 120 sec. Gado.-chelates 0,1mmol/kg 2-3ml/s, saline flush (20-30ml)
  • 19. Improve specificity : 3T MRI ? Adequat sequences : 2nd Week of menstrual cycle At least one unenhanced high-contrast sequence (T2 FSE) 2D or 3D T1-w. dynamic seq. : pixel < 1,5 mm2, thickness < 4mm, < 120 sec. Gado.-chelates 0,1mmol/kg 2-3ml/s, saline flush (20-30ml) Centre Oscar Lambret - 3T : 3D Vibrant (GE) 5 x 80 secondes Pixel 0,66 mm2, Thickness 2,2mm, No Gap. S1 begining injection 20sec. before the end, 4 post injection
  • 20. Improve specificity : 3T MRI ? Adequat sequences : 2nd Week of menstrual cycle At least one unenhanced high-contrast sequence (T2 FSE) 2D or 3D T1-w. dynamic seq. : pixel < 1,5 mm2, thickness < 4mm, < 120 sec. Gado.-chelates 0,1mmol/kg 2-3ml/s, saline flush (20-30ml) Centre Oscar Lambret - 3T : 3D Vibrant (GE) 5 x 80 secondes Pixel 0,66 mm2, Thickness 2,2mm, No Gap. S1 begining injection 20sec. before the end, 4 post injection No studies demonstrate 3T > 1,5T Best spatiale resolution Best temporal resolution : 15 - 20 mn T1 + T2 + DWI-w + 3D dynamic + Late Sequence (DCIS)
  • 21. Improve specificity : DWI-MRI ? 2009 : 13 / 65 tudes 615 Cancers, 349 LB b 1000 -Se : 0.84 [0.8-0.87]; Sp 0.84 [0.79-0.88]
  • 22. 93 women, 101 lesions. 3T, b0, b600. 33 BL : 9 FA, 3 intraductal Papillomas, 4 Fibrocystic L, 4 sclerosing aden. 2 ADHL, 11 areas of benign breast tissue 68 K : 23 IDC, 26 IDC+DCIS, 9 DCIS, 6 ILC, 4 others
  • 23. 27 y-o. Pregnant : 8 Weeks Le6 B : IDC Grade 3 RE-, RP-, Her2 -.
  • 24. 27 y-o. Pregnant : 8 Weeks Le6 B : IDC Grade 3 RE-, RP-, Her2 Right B : ? S3 Diffusion b 1000 Native 3 ADC
  • 25. 27 y-o. Pregnant : 8 Weeks LB : IDC Grade 3 RE-, RP-, Her2 RB : ? ADC: 2, ADC: 0,86.10-3 ADC: 1,26.10-3
  • 26. 27 y-o. Pregnant : 8 Weeks LB : IDC Grade 3 RE-, RP-, Her2 RB : ? ADENOSIS ADC: 2, ADC: 0,86.10-3 ADC: 1,26.10-3
  • 27. 54 y-o. MulKfocalit on mammography ? RB : 2nd lesion : Birads 5
  • 28. 54 y-o. MulKfocalit on mammography ? RB : 2nd lesion : Birads 5
  • 29. 54 y-o. MulKfocalit on mammography ? RB : 2nd lesion : Birads 5
  • 30. 54 y-o. MulKfocalit on mammography ? LB :
  • 31. 54 y-o. MulKfocalit on mammography ? LB : Lymph node
  • 32. Artefacts frquents. Courtesy Dr C.Balleyguier
  • 33.