AdvancesinMagneticResonance TechnologyandApplicationsSeries
SeriesEditors
In-YoungChoi,PhD
DepartmentofNeurology,DepartmentofRadiology,DepartmentofMolecular&Integrative Physiology,HoglundBiomedicalImagingCenter,UniversityofKansasMedicalCenter,KansasCity, KS,UnitedStates
PeterJezzard,PhD
WellcomeCentreforIntegrativeNeuroimaging,NuffieldDepartmentofClinicalNeurosciences UniversityofOxford,Oxford,UnitedKingdom
BrianHargreaves,PhD
DepartmentofRadiology,DepartmentofElectricalEngineering,DepartmentofBioengineering StanfordUniversity,Stanford,CA,UnitedStates
GregZaharchuk,MD,PhD
DepartmentofRadiology,StanfordUniversity,Stanford,CA,UnitedStates
Titlespublished:
Volume1–QuantitativeMagneticResonanceImaging–EditedbyNicoleSeiberlichandVikasGulani Volume2–HandbookofPediatricBrainImaging–EditedbyHaoHuangandTimothyRoberts
Volume3–HyperpolarizedCarbon-13MagneticResonanceImagingandSpectroscopy–Editedby PederLarson
Volume4–AdvancedNeuroMRTechniquesandApplications–EditedbyIn-YoungChoiandPeter Jezzard
Volume5–BreastMRI-EditedbyKatjaPinker,RitseMannandSavannahPartridge
Editedby
KatjaPinker,MD,PhD
DepartmentofRadiology,BreastImagingService,MemorialSloan KetteringCancerCenter,NewYork,NY,UnitedStates
RitseMann,MD,PhD
DepartmentofMedicalImaging,Radboudumc,Nijmegen, Netherlands; DepartmentofRadiology,TheNetherlandsCancerInstitute, Amsterdam,Netherlands
SavannahPartridge,PhD
DepartmentofRadiology,UniversityofWashington,Seattle,WA, UnitedStates
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Notices
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TypesetbyTNQTechnologies
Pseudoangiomatousstromalhyperplasia.............................................................122
CHAPTER15Breastaugmentationandpostmastectomyautologousbreast
reconstructiononbreastMRI ........................................................
261
JuliaCamps-HerreroandSilviaPe´rez-Rodrigo
Introduction..........................................................................................................261
Breastaugmentationandimplant-basedreconstruction.....................................262
Freesiliconeinjection.........................................................................................283
Free-fatinjection,lipofilling,lipomodeling,orautologousfatgrafting............283
Autologousflaps..................................................................................................286
Latissimusdorsiflap............................................................................................294
TRAM(transverserectusabdominusmuscle)flap.............................................295
DIEP(deepinferiorepigastricperforator)flap...................................................296
EraldaMemaandRichardHa Introduction..........................................................................................................323
Anatomyoftheaxilla..........................................................................................324
Spreadofmetastaticdiseasetoaxillarylymphnodes........................................324 Evaluationofaxillarylymphnodes....................................................................324
MRimagingoftheaxilla....................................................................................325
DetectionofabnormalaxillarylymphnodesonMRI........................................326
Clinicalmanagementofmetastaticaxillarylymphnodes.................................329
Radiotherapy........................................................................................................329
Chemotherapy......................................................................................................330
Thecontroversialroleofimaginginaxillarystaging........................................330
RoleofMRIinthedetectionandtreatmentofoccultprimarybreast cancer...................................................................................................................330
Interventionaltechniquesforaxillarylymphnodelocalizationand
DWMRIasasupplementtoconventionalDCE-MRI.......................................385
CHAPTER21Metabolicimagingusingultra-highfieldMRI ..............................
LiekevandenWildenberg,JannieP.WijnenandDennisW.J.Klomp Introduction..........................................................................................................411
CHAPTER22QuantitativeDCE-MRIoftheBreast ...............................................
WeiHuang
CHAPTER23DiffusionMRIofthebreast:standardandadvanced techniques
MayaHonda,EricSigmund,MasakoKataoka,DenisLeBihanand MamiIima Introduction..........................................................................................................459
CHAPTER24MRspectroscopy ............................................................................
SunithaThakurandAlmirBitencourt Introduction..........................................................................................................485
CHAPTER25EmergingtechniquesinbreastMRI ...............................................
AnumS.Kazerouni,AdrienneN.Dula,AngelaM.Jarrett, GuillermoLorenzo,JaredA.Weis,JamesA.Bankson, EduardY.Chekmenev,FedericoPineda,GregoryS.Karczmarand ThomasE.Yankeelov
Introduction..........................................................................................................504
Ultrafastdynamiccontrast-enhancedimaging....................................................504
Magneticresonanceelastography.......................................................................507
Magnetizationtransferandchemicalexchangesaturationtransfer...................509
Magneticresonancespectroscopy.......................................................................512
Hyperpolarized[1-13C]-pyruvate........................................................................514
MRI-constrainedradiomicsandhabitatimaging................................................517
MRI-constrainedmathematicalmodeling...........................................................519
SECTION6 Hybridimagingandalternativetechniques
CHAPTER26PET/MRIhybridimagingandtargetedtracers
ValeriaRomeo,JulianKirchner,ChristophRischpler,LaleUmutluand
CHAPTER27CompetingandalternativetechniquestobreastMRI
MollyHoganandMaxineJochelson
Contrast-enhancedmammography......................................................................557
Breast-specificgammaimagingandmolecularbreastimaging.........................565
Positronemissiontomographyandpositronemissionmammography ofthebreast.........................................................................................................569
Futuredirections..................................................................................................569 References............................................................................................................570
SECTION7 PrognosticandpredictiveMRimagingbiomarkers
CHAPTER28MRIradiomicsandradiogenomicsforbreastcancer ..................
VivianBelenky,RheaChitaliaandDespinaKontos
Introduction..........................................................................................................575
Prognosticandpredictiveradiomicbiomarkersforbreastcancer.....................578
CHAPTER29Breastimaginganddeeplearning:past,present,andfuture ......
SarahEskreis-Winkler,JonasTeuwenandSeanBenson
Thispageintentionallyleftblank
Contributors
HiroyukiAbe,MD,PhD
DepartmentofRadiology,TheUniversityofChicagoMedicine,Chicago,IL,UnitedStates
NitaAmornsiripanitch,MD
DepartmentofRadiology,BrighamandWomen’sHospitalandHarvardMedicalSchool,Boston, MA,UnitedStates
FirouzehK.Arjmandi,MD
DepartmentofRadiology,BreastImagingDivision,TheUniversityofTexasSouthwesternMedical Center,Dallas,TX,UnitedStates
DanaAtaya,MD
DepartmentofDiagnosticImagingandInterventionalRadiology,DivisionofBreastImaging,H. LeeMoffittCancerCenterandResearchInstitute,FL,UnitedStates
AlexandraAthanasiou,MD,MSc
DepartmentofRadiology,BreastImagingService,MITERAHospital,Athens,Greece
DalyAvendano,MD
DepartmentofBreastImaging,BreastCancerCenterTecSalud,InstitutoTecnolo ´ gicodeEstudios Superiores(ITESM)Monterrey,NuevoLeon,Mexico
PascalA.T.Baltzer,MD
DepartmentofBiomedicalImagingandImage-guidedtherapy,DivisionofMolecularand StructuralPreclinicalImaging,MedicalUniversityofVienna,Vienna,Austria
JamesA.Bankson
DepartmentofImagingPhysics,TheUniversityofTexasMDAndersonCancerCenter,Houston, TX,UnitedStates
VivianBelenky,MS
DepartmentofRadiology,UniversityofPennsylvania,Philadelphia,PA,UnitedStates
SeanBenson,PhD
NetherlandsCancerInstitute,Amsterdam,TheNetherlands
SonyaBhole,MD
DepartmentofRadiology,NorthwesternMedicinePrenticeWomen’sHospital,Chicago,IL,United States;DepartmentofRadiology,NorthwesternUniversityFeinbergSchoolofMedicine,Chicago, IL,UnitedStates
AlmirBitencourt,MD,PhD
ImagingDepartment,A.C.CamargoCancerCenter,SaoPaulo,Brazil
JuliaCamps-Herrero,MD
DepartmentofBreastHealth,Radiology,RiberaHospitals,Valencia,Spain
EduardY.Chekmenev
DepartmentofChemistry,KarmanosCancerInstitute,IntegrativeBiosciences,WayneState University,Detroit,MI,UnitedStates;RussianAcademyofSciences,Moscow,Russia
YunAnChen,MD
DepartmentofRadiology,UniversityofWashington,Seattle,WA,UnitedStates
RheaChitalia,PhD
DepartmentofRadiology,UniversityofPennsylvania,Philadelphia,PA,UnitedStates
NariyaCho,MD,PhD
DepartmentofRadiology,SeoulNationalUniversityHospital,SeoulNationalUniversityCollegeof Medicine,Seoul,SouthKorea
EthanOrenCohen,MD
DepartmentofBreastImaging,DivisionofDiagnosticImaging,TheUniversityofTexasMD AndersonCancerCenter,Houston,TX,UnitedStates
ChristopherComstock,MD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
BasakE.Dogan,MD
DepartmentofRadiology,BreastImagingDivision,TheUniversityofTexasSouthwesternMedical Center,Dallas,TX,UnitedStates
MicheleB.Drotman,MD
DepartmentofRadiology,WeillCornellMedicalCollege,NewYork,NY,UnitedStates
AdrienneN.Dula,MD
DepartmentofNeurology,TheUniversityofTexasatAustin,Austin,TX,UnitedStates
SarahEskreis-Winkler,MD,PhD
DepartmentofRadiology,MemorialSloanKetteringCancerCenter,NewYork,UnitedStates
SarahFriedewald,MD
DepartmentofRadiology,NorthwesternMedicinePrenticeWomen’sHospital,Chicago,IL,United States;DepartmentofRadiology,NorthwesternUniversityFeinbergSchoolofMedicine,Chicago, IL,UnitedStates
FrancescaGalati,MD,PhD
DepartmentofRadiological,OncologicalandPathologicalSciences,SapienzaUniversityofRome, Rome,Italy
LarsJ.Grimm,MD,MHS
DepartmentofRadiology,DukeUniversity,Durham,NC,UnitedStates
RichardHa,MD,MS
DepartmentofRadiology,ColumbiaUniversityMedicalCenter,NewYork,NY,UnitedStates
MollyHogan,MD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
MayaHonda,MD
DepartmentofDiagnosticImagingandNuclearMedicine,KyotoUniversityGraduateSchoolof Medicine,Kyoto,Japan;DepartmentofDiagnosticRadiology,KansaiElectricPowerHospital, Osaka,Japan
WeiHuang,PhD
AdvancedImagingResearchCenter,OregonHealth&ScienceUniversity,Portland,OR,United States
MamiIima,MD,PhD
DepartmentofDiagnosticImagingandNuclearMedicine,KyotoUniversityGraduateSchoolof Medicine,Kyoto,Japan;InstituteforAdvancementofClinicalandTranslationalScience(iACT), KyotoUniversityHospital,Kyoto,Japan
AngelaM.Jarrett
OdenInstituteforComputationalEngineeringandSciences,TheUniversityofTexasatAustin, Austin,TX,UnitedStates;LivestrongCancerInstitutes,TheUniversityofTexasatAustin,Austin, TX,UnitedStates
MaxineJochelson,MD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
TheodoraKanavou,MD,PhD
PrivateMedicalPractice,Larissa,Greece
GregoryS.Karczmar,MD
DepartmentofRadiology,TheUniversityofChicago,Chicago,IL,UnitedStates
MasakoKataoka,MD,PhD
DepartmentofDiagnosticImagingandNuclearMedicine,KyotoUniversityGraduateSchoolof Medicine,Kyoto,Japan
AnumS.Kazerouni
DepartmentofRadiology,UniversityofWashington,Seattle,WA,UnitedStates
S.GeneKim,PhD
DepartmentofRadiology,WeillCornellMedicalCollege,NewYork,NY,UnitedStates
JulianKirchner,MD
DepartmentofDiagnosticandInterventionalRadiology,MedicalFaculty,UniversityDusseldorf, Dusseldorf,Germany
DennisW.J.Klomp,PhD
DepartmentofRadiology,UniversityMedicalCenterUtrecht,Utrecht,Netherlands
DespinaKontos,PhD
DepartmentofRadiology,UniversityofPennsylvania,Philadelphia,PA,UnitedStates
DenisLeBihan,MD,PhD
NeuroSpin,JoliotInstitute,Paris-SaclayUniversity,CEA-SaclayCenter,Gif-sur-Yvette,France
JessicaWaiTingLeung,MD
DepartmentofBreastImaging,DivisionofDiagnosticImaging,TheUniversityofTexasMD AndersonCancerCenter,Houston,TX,UnitedStates
RobertoLoGullo,MD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
GuillermoLorenzo
OdenInstituteforComputationalEngineeringandSciences,TheUniversityofTexasatAustin, Austin,TX,UnitedStates;DepartmentofCivilEngineeringandArchitecture,UniversityofPavia, Pavia,Italy
RitseM.Mann,MD,PhD
DepartmentofMedicalImaging,Radboudumc,Nijmegen,Netherlands;Departmentof Radiology,TheNetherlandsCancerInstitute,Amsterdam,Netherlands
MariaAdeleMarino,MD
DepartmentofBiomedicalSciencesandMorphologicandFunctionalImaging,Universityof Messina,Messina,Italy
EraldaMema,MD
DepartmentofRadiology,WeillCornellMedicalCenter,NewYork,NY,UnitedStates
ClaireHelenMeriwether,MD
DepartmentofRadiology,UniversityofCalifornia,SanDiego,CA,UnitedStates
NaokoMori,MD,PhD
DepartmentofDiagnosticRadiology,TohokuUniversityGraduateSchoolofMedicine,Sendai, Japan
LindaMoy,MD
DepartmentofRadiology,NYUGrossmanSchoolofMedicine,NewYork,NY,UnitedStates
MarybethNedrud,MD,PhD
DepartmentofRadiology,DukeUniversity,Durham,NC,UnitedStates
BethanyL.Niell,MD,PhD
DepartmentofDiagnosticImagingandInterventionalRadiology,DivisionofBreastImaging,H. LeeMoffittCancerCenterandResearchInstitute,FL,UnitedStates
HaydeeOjeda-Fournier,MD
DepartmentofRadiology,UniversityofCalifornia,SanDiego,CA,UnitedStates
SavannahPartridge,PhD
DepartmentofRadiology,UniversityofWashington,Seattle,WA,UnitedStates
FedericaPediconi,MD
DepartmentofRadiological,OncologicalandPathologicalSciences,SapienzaUniversityofRome, Rome,Italy
SilviaPe ´ rez-Rodrigo,MD
DepartmentofBreastRadiology,MDAndersonCancerCenter,Madrid,Spain;Departmentof BreastRadiology,HospitalQuiro ´ nLaLuz,Madrid,Spain
FedericoPineda
DepartmentofRadiology,TheUniversityofChicago,Chicago,IL,UnitedStates
KatjaPinker,MD,PhD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
HabibRahbar,MD
DepartmentofRadiology,UniversityofWashington,Seattle,WA,UnitedStates
RebeccaRakow-Penner,MD,PhD
DepartmentofRadiology,UniversityofCalifornia,SanDiego,CA,UnitedStates
SandraRao,MD
DepartmentofRadiology,NorthwesternMedicinePrenticeWomen’sHospital,Chicago,IL,United States;DepartmentofRadiology,NorthwesternUniversityFeinbergSchoolofMedicine,Chicago, IL,UnitedStates
ChristophRischpler,MD
DepartmentofNuclearMedicine,UniversityHospitalEssen,UniversityofDuisburg-Essen,Essen, Germany
ValeriaRomeo,MD,PhD
DepartmentofAdvancedBiomedicalSciences,UniversityofNaples“FedericoII”,Naples,Italy
DavidSchacht,MD,MPH
DepartmentofRadiology,NorthwesternMedicinePrenticeWomen’sHospital,Chicago,IL,United States;DepartmentofRadiology,NorthwesternUniversityFeinbergSchoolofMedicine,Chicago, IL,UnitedStates
DeepaSheth,MD
DepartmentofRadiology,TheUniversityofChicagoMedicine,Chicago,IL,UnitedStates
EricSigmund,PhD
DepartmentofRadiology,NYULangoneHealth,NewYork,UnitedStates
CarmeloSofia,MD
DepartmentofBiomedicalSciencesandMorphologicandFunctionalImaging,Universityof Messina,Messina,Italy
JaniceS.Sung,MD
DepartmentofRadiology,BreastImagingService,MemorialSloanKetteringCancerCenter,New York,NY,UnitedStates
JonasTeuwen,PhD
NetherlandsCancerInstitute,Amsterdam,TheNetherlands
SunithaThakur,PhD
DepartmentofMedicalPhysics,MemorialSloanKetteringCancerCenter,NewYork,NY,United States;DepartmentofRadiology,MemorialSloanKetteringCancerCenter,NewYork,NY,United States
LaleUmutlu,MD
DepartmentofDiagnosticandInterventionalRadiologyandNeuroradiology,UniversityHospital Essen,Essen,Germany
LiekevandenWildenberg,MSc
DepartmentofRadiology,UniversityMedicalCenterUtrecht,Utrecht,Netherlands
JaredA.Weis,MD
DepartmentofBiomedicalEngineering,WakeForestSchoolofMedicine,Winston-Salem,North Carolina,UnitedStates
JannieP.Wijnen,PhD
DepartmentofRadiology,UniversityMedicalCenterUtrecht,Utrecht,Netherlands
ThomasE.Yankeelov,PhD
OdenInstituteforComputationalEngineeringandSciences,TheUniversityofTexasatAustin, Austin,TX,UnitedStates;LivestrongCancerInstitutes,TheUniversityofTexasatAustin,Austin, TX,UnitedStates;DepartmentofImagingPhysics,TheUniversityofTexasMDAndersonCancer Center,Houston,TX,UnitedStates;DepartmentsofBiomedicalEngineering,Diagnostic Medicine,andOncology,TheUniversityofTexasatAustin,Austin,TX,UnitedStates
Preface
Breastcancerhaslongbeenoneofthemostcommoncancersandcauseofcancer-relateddeaths amongwomenworldwide.Despitenumerousadvancementsinpersonalizedtherapies,earlybreast cancerdetectionremainsofparamountimportance.Specifically,imaging-basedscreeninghas demonstratedclearadvantagestoimprovebreastcanceroutcomes.Inaddition,almostallwomenand asubstantialnumberofmenwillexperiencesomesortofbreast-relatedissueduringtheirlife.While mostofthesecomplaintsrelatetophysiologicalchangesorbenignbreastabnormalities,somearise frombreastcancerthatwhenleftuntreatedbecomesadeadlydisease.Sinceanaccuratediagnosis basedonclinicalassessmentisoftenchallenging,thereisacriticalneedforaccuratenoninvasive imagingmethodstoevaluatebreast-relatedcomplaintsandtodistinguishbenignchangesfrombreast cancer.
Inpastdecades,avarietyofdifferentimagingtechniques(includingbutnotlimitedtoX-raybased, ultrasound,andoptoacousticimaging)havebeenusedfortheassessmentofbreast-relatedcomplaints andthedetectionbreastcancer.Acrossthesetechniques,contrast-enhancedbreastMRIhasprevailed asthemostsensitiveandspecificmethodtodetectanddistinguishbreastcancerfrombenignlesions, toexplainotherfindingsand,whennecessary,toguidetreatment.
Incomparisontomammographyorultrasound,breastMRIisarelativelyyoungtechnique.Initial studiesintheearly1980sfocusedonsignalvariationsinstandardT1-andT2-weightedsequences, withlimitedsuccess.AgamechangerforbreastMRIwastheadditionofafunctionalcomponent throughtheapplicationofanintravenouscontrastagent,whichledtobreastcancerssuddenlybeing easilyidentifiable.Thus,thefirstcontrast-enhancedstudiesinthemid-1980sarenowregardedasthe birthofmodernbreastMRI.
Contrast-enhancedbreastMRIexploitsthewell-documentedhypervascularityofcancersand leakinessoftheneovesselswhichareabundantinandaroundthetumor.Mainlybecauseofextravasation,thecontrastagentaccumulatesinthetumorareaandresultsinthelocalshorteningoftheT1 relaxationtime,leadingtoenhancementonT1-weightedimages.EvenastaticpostcontrastbreastMR imageprovidesfunctionalinformationonthepermeabilityinandaroundalesion.ThissetsbreastMRI apartfromallothercommonlyusedbreastimagingtechniqueswhicharedrivenbymorphologicrather thanfunctionalchanges.Furtherdevelopmentoftechniquestoimprovethevisibilityoflocal enhancement,suchassubtractionandfatsuppressionandthegenerationofmaximumintensity projections,hastransformedbreastMRIintothetechniquethatwearenowallfamiliarwith.
WhileinitiallybreastMRIwasprimarilyreservedforproblemsolving,itrapidlybecameapparent thatthetechniquerevealsbreastcancerthatisoccultonmammographyandultrasound.Thevisualizationofsmalladditionalmalignantsatellitelesionslocatedaroundknowncancersaswellasthe incidentaldetectionofcompletelyoccultcontralateralcancersmadeitveryclearthatweinfactmiss diseasewhenrelyingonanatomicimagingtechniquesalone.ThenextimportantstepintheimplementationofbreastMRIintheclinicalparadigmwasthedevelopmentofMRI-guidedbreastbiopsyin theearly1990s.TheabilitytoselectivelytargetlesionsthatareonlyvisibleonbreastMRIallowedthe avoidanceofunnecessarysurgeriesandpromotedabetterunderstandingofthenaturetheselesions. Similartotheearlierrealizationwithmammographythatcalcificationsmayharborductalcarcinoma insitu(DCIS),itbecameevidentthatwithbreastMRI,notonlyenhancingmassesbutalsospecific
typesofnonmassenhancement(ornonmass-likeenhancementasitwasoriginallycalled)may representhallmarksofbreastcancer,furtherimprovingthesensitivityofbreastMRI.
TostandardizethereportingofMRIofthebreastandtominimizefalse-positiveresultswithout compromisingitssensitivity,theAmericanCollegeofRadiology(ACR)addedanMRIlexicontothe BreastImagingReportingandDataSystem(BI-RADS)atlasin2003,whichfurtherassistedthe recognitionoftheimportantfeaturesofenhancingbreastlesions.
WhilebreastMRIhasseenalotofsuccessintheclinicalparadigm,ithasalsobeenheavilycriticized onseveralaspects.Duetothestrongwishnottomissanycancers,specificitywassacrificedintheearly yearsofitsimplementation.Thisresultedinahighrelativerateoffalse-positivefindingsandsubsequent unnecessarybiopsiesforbenignlesions.InordertoimprovethespecificityofbreastMRI,asearchfor discriminatingfeaturesusingmanydifferentcomplementaryMRIsequenceswasbegun.Initialandlate enhancementpatternsappearedtobequitespecific,withbreastcancersexhibitingrapidwash-inand earlywash-out.Highwatercontentandlowcellularitywerelikewisemainlyobservedinbenignbreast lesions.ThishasledtothealmoststandardincorporationofdynamicacquisitionsacrossbreastMRI protocolsandlateralsoofT2-weightedanddiffusion-weightedimaging(DWI)acquisitions.The resultingmultiparametricprotocolsareregardedasthestate-of-the-artprotocolsforbreastMRI.
ThehighsensitivityofbreastMRIledtoitbeingrapidlyputtouseforthepurposesofbreastcancer screeningandstaging.EarlyreportsonscreeningwithMRIinwomenatincreasedriskappearedinthe early2000sandwererapidlyfollowedbylarge-scalestudies,ultimatelyleadingtotheadoptionof MRIscreeningforwomenwithalifetimeriskof20%ormorebytheAmericanCancerSocietyin 2007.Morerecentstudies,however,showthatthebenefitintermsofearliercancerdetectionand reductionofintervalcancersisnotlimitedtowomenatveryhighrisk,withMRIoutperforming mammographyeveninwomenataveragerisk.Asforbreastcancerstaging,manysocietieshave adoptedbreastMRIforthestagingofwomenwithknownbreastcancer,particularlywhenthewomen areveryyoung,haveverydensebreastsasseenonmammography,orthelesionextentisunclear,such asformanyinvasivelobularcancers.Inlightoftheincreasingpopulationofpatientstreatedwith preoperativesystemictherapy,MRIhasalsobecomeawidelyusedtoolforassessingresponseandis includedinResponseEvaluationCriteriainSolidTumors(RECIST)guidelines.
Noveldevelopmentsandchangestothescreeningparadigmaredrivenbytherealizationthat dependingonthesituation,theapriorilikelihoodthataspecificfindingismalignantvaries.Inhighriskindividuals,lesionsneedtobeassessedinadifferentandusuallymoreextensivemannerthan whenthebaselineriskofcancerisrelativelylow.Withthisinmind,itmaybeadvantageoustoadapt theMRIprotocolappropriatelytoperformarapid“abbreviated”MRIexaminwomenatlowriskof abnormalities,whereasinwomenwithcomplexpathology,thelesionscanbescrutinizedwithfull multiparametricMRIevaluations.
SincedifferentMRIsequencesreflectvaryingunderlyingbiologicalfactors,breastMRImayalso provideimportantpredictiveandprognosticinformationforpatientswithbreastcancer,whichmaybe usedtotailorthetreatment.ThestandardizationandquantificationofMRIsignals,eitherthrough physics-basedapproaches,radiomics,ordeeplearning,mayfurtherleadtothedevelopmentof imaging-basedtumorprofiles.Thisisanexcitingareaofresearchasitmayallowinvivoassessmentof thepresenceofvaryingtumorhabitatswithinasinglepatient,whichcannotbeassessedonabiopsy specimen.Potentially,suchanalysesmaythusbecomplementarytohistopathologicalassessmentand helptoimprovetherapyselection.Thesedevelopmentsthereforeplayakeyroleintheexpandingfield ofprecisionmedicine.
ThenumberofwomenforwhombreastMRIappearstobebeneficialisconstantlyexpandingin avarietyofdifferentclinicalscenarios,includingbutnotlimitedtoscreening,staging,treatment responseassessment,implantevaluation,andproblemsolving.Athoroughunderstandingofthe benefitsandlimitationsofbreastMRIfromphysiciansandresearcherswhoareactivelyinvolvedinthe diagnosisandtreatmentofpatientswithbreastdiseaseaswellasfrompatientsispivotaltoenable a“shareddecision-making”process.
Thisbookaimstoprovideessentialbackgroundknowledgeforclinicalpracticeandresearch endeavorsinthefieldofbreastimaging.Itisdividedintwoparts,eachcomposedofanumberof subsections:
ThefirstpartofthebookdescribesthecurrentstateoftheartinbreastMRI.
•InSection1,standardandabbreviatedbreastMRIprotocolsarefirstdiscussed.Adedicatedchapter coversartifactsonbreastMRI,whichmayaidinovercomingcommonpitfallsinimageacquisition. Thissectionsubsequentlycontinueswithreportingstandards,includingtheassessmentofbreast MRIaccordingtotheBI-RADSlexicon,andtheuseoftheKaiserscoreasasupplementaltool tocharacterizebreastlesions.
•Section2focusesontheappearanceofcommonandlesscommonbenignandmalignantbreast lesions.Chaptersonbenignabnormalities,high-risklesions,DCIS,andinvasivecancers highlightthehallmarkfeaturesofthesevariousentitieswhichareusefulfordiagnosis,aswell asotherattributesthatmayindicatethatcertainlesionsarenotwhattheyseematfirstglance.
•Section3focusesontheindicationsforwhichbreastMRIiscurrentlyused.Thissectionhighlights theroleorMRIinscreening,staging,andassessmentofsystemictreatmentresponse.Inthecontext ofcosmeticandoncoplasticbreastinterventions,twochaptersfocusonthepostoperativebreast, bothtoincreaseawarenessregardingtherelevantsurgicalproceduresandhowtoreport complications,andtodetectrecurrencesinwomenpreviouslytreatedforbreastcancer.
•Section4isconcernedwiththestateoftheartofbreastMRI–guidedinterventions.Thefirst chapterinthissectiondetailsthestandardprocedureandsuccessrateofbreastMRI–guided biopsies.ThenextchapterventuresfurtherintoMRI-guidedminimallyinvasivetherapy.
ThesecondpartofthebookaddressesthefutureofbreastMRIanddiscussesimportantnovel developmentsthatmayeventuallychangethewaywecurrentlyimplementandperformbreastMRI.
•Section5focusesonnovelwaystodetectcancerusingvariousMRIcontrastagentsandphysicsbasedmodelinginorderthatbreastMRImaydevelopintoafullynoninvasivetechniquethatcan fingerprintthebreasttissuewithunprecedentedaccuracy.
•InSection6,hybridMRI-basedimagingandotherperfusion-basedmethodssuchascontrastenhancedmammographyandmolecularbreastimagingarediscussed.
•Finally,Section7looksattheuseofradiomicsanddeeplearning–basedartificialintelligence methodsthatarebeingexploredtoreleasetheuntappedpotentialoftheMRimages.Altogether, themethodspresentedinPart2ofthisbookmayrevolutionizeourcurrentunderstandingof breastimagingingeneralandtheroleofbreastMRIinparticular.
Thisbookprovidesabasisfortheoptimizationofbreastcare,exploitingthelimitlesspossibilities offeredbybreastMRI.Wearegratefulfortheexceptionalandenthusiasticcontributionof
aworldwidenetworkofexpertswhoallprovidedimportantpiecesofthepuzzlethatisbreastMRI.We countonthebreastimagingcommunitytoputthecontentsofthisbooktoworkinordertohelpthe countlesswomenintheworldwhoareconfrontedwithbreastdisease.
