Breast Imaging Using 3D-GRE

Dr. Fred Kelcz University of Wisconsin, Madison Madison, Wisconsin

At the University of Wisconsin, Madison, a 3D gradient echo sequence (efgre3d) is used routinely to perform breast MR exams for certain clinical indications. Images are obtained both pre- and post-contrast agent injection at the same location, with matched timing parameters and equal spatial resolution. Enhancing lesions are made more conspicuous either by using fat suppression, or by subtracting the pre-contrast images from the post-contrast images. Analysis of the contrast agent uptake is performed using the GE Functool processing software.

Case A:

Case A:

A 40 year old woman with lymphoblastic leukemia with recurrence in the right breast. An MRI exam was ordered to rule out breast disease in the opposite breast. The patient has implants making diagnosis by mammography unreliable.

MRI shows two large deposits of increased signal intensity in the breast (Fig A1). Series 7, image 24 shows the implant and a broad area of enhancement along the inferior breast. Dynamic series FuncTool showed a slow uptake not typical of invasive ductal cancer. MRI showed no evidence of disease in the left breast.


Case B:

Case B:

A 50 year old woman with a palpable lump at the 5 o'clock position in the left breast. Mammography showed only dense tissue, but ultrasound detected an 11mm lesion which was biopsied and showed to be an invasive ductal cancer. MRI showed a well marginated lesion with internal septations at L120 but with rapid washout typical of malignancy. Furthermore, two other lesions, at L134 and L120 are seen, and were also considered suspicious on the basis of the contrast uptake characteristics.

Series 3, Image 138 shows the lesion along the inferior breast with a second satellite lesion located anterior and superior, but nearby the lesion. Fig B1 and Fig B2 show the lesion pre- and immediately post-contrast injection, respectively. Fig B3 is a subtraction image. Fig B4 is a Negative Enhancement Integral map obtained using Functool, and Fig B5 shows the enhancement curve from a Region of Interest on the lesion. The enhancement curve shows rapid uptake and rapid wash-out of the contrast agent, considered typical for invasive ductal carcinoma.


Case C:

Case C:

A 69 year old woman with axillary adenopathy and dense breast without a definite lesion. The pathologist was unsure if it was breast adenocarcinoma. Clinical MRI was performed and showed two focal lesions, confirmed by MRI-guided biopsy to be malignant invasive ductal cancer. Fig C1 and C2 show the lesions post-contrast injection using fat suppression.


Case D:

Case D:

A 49 year old woman with a normal mammogram a few months prior to feeling a lump. MRI shows 15 mm rapidly enhancing classic spiculated malignancy in the anterior breast. The lesion was virtually invisible on mammography although this patient had average density breasts.


Case E:

Case E:

A 47 year old woman with a 1cm lesion seen on mammography. The patient had an ultrasound-guided FNA showing fibroadenoma. The pre- and post-contrast images are shown in Figs E1 and E2, with a Functool map of the Negative Enhancement Integral shown in Fig E3. Post-contrast MRI showed rapid uptake, but no wash-out (Fig E4). This is considered typical of fibroadenoma.


Case F:

Case F:

A 47 year old woman with a questionable lesion seen on mammography and sent for clinical MRI. The MRI confirmed retroaureolar rapidly enhancing mass with rapid uptake and washout (Figs F1-F3). There was concern for malignancy and FNA was performed using ultrasound guidance which showed fibroadenoma. Internal septation and smooth contour on the MR exam speak for fibroadenoma, but the rapid washout is considered more typical for malignancy. We have found that about 10% of fibroadenomas exhibit rapid washout, causing confusion with malignancy.


Case G:

Case G:

A 50 year old woman with diffuse microcalcifications in the inferior breast suspicious for DCIS. She volunteered for research MRI which showed a broad area of enhancement along the inferior breast in the area of enhancement. FuncTool shows some areas of washout. Overall findings are consistent with various grades of DCIS with probable areas of invasive cancer, but so far, only core biopsy has been done (DCIS, intermediate grade).