Pinker k., Mann R., Partridge S. Breast MRI: State of the Art and Future Directions

London: Academic Press, 2022. — 646 p.Breast MRI: State-of-the-Art and Future Directions provides a comprehensive overview of the current applications of breast MRI, including abbreviated MRI, as well as presenting technical recommendations, practical implementation, and associated challenges in clinical routine. In addition, the book introduces novel MRI techniques, multimodality imaging, and advanced image processing coupled with AI, reviewing their potential for impeding and future clinical implementation. This book is a complete reference to state-of-the-art breast MRI methods suitable for MRI researchers, radiographers, and clinicians.Breast cancer is one of the leading causes of death among women with early detection being the key to improved prognosis and survival. Magnetic resonance imaging (MRI) of the breast is undisputedly the most sensitive imaging method to detect cancer, with a higher detection rate than mammography, digital breast tomosynthesis, and ultrasound.State-of-the-art.
Performance and interpretation of breast MRI.
Multiparametric breast MRI in clinical practice.T1-weighted imaging.
Standard dynamic contrast-enhanced MRI.
T2-weighted imaging.
Diffusion-weighted imaging.
Other specific imaging sequences.Abbreviated and Ultrafast MRI.Abbreviated MRI protocols.
Recent MRI screening studies.
Benefits and challenges of abbreviated MRI.
Ultrafast MRI (high temporal resolution MRI).
Hybrid imaging — abbreviated ultrafast MRI.
Recent MRI screening studies.Artifacts in breast MRI.Motion artifacts.
Fat.
Chemical shift artifact of the first kind.
Chemical shift artifact of the second kind.
Artifacts related to fat suppression.
Susceptibility.
Other artifacts.Standard terminology and reporting – Breast Imaging Reporting & Data System: magnetic resonance imaging.Standard terminology.
Descriptors of breast tissue composition.
Descriptors of enhancing lesions.
Focus.
Mass.
Nonmass enhancement.
Other descriptors.
Intramammary lymph node.
Skin lesion.
Nonenhancing findings.
Associated features.
Fat-containing lesions.
Location of lesion.
Kinetic curve assessment.
Implants.
Reporting.The Kaiser score: an evidence-based clinical decision rule for dynamic contrast-enhanced breast MRI.
Introduction: why do we need the Kaiser score in breast MRI?
Description of the Kaiser score and its criteria.
Diagnostic criteria.
Spiculations (Dr. Kaiser's “root sign”).
Dynamic enhancement characteristics (enhancement curve type).
Margins.
Internal enhancement characteristics.
Edema.
The Kaiser score.
Application of the Kaiser score in clinical practice.
Considering the clinical context.
Future directions: integration with other biomarkers and automated analyzes.Background parenchymal enhancement at breast MRI.MRI appearance of BPE.
BPE, breast density, and FGT.
Biological basis of BPE.
Factors influencing BPE.
BPE and diagnostic performance.
Qualitative and quantitative assessments of BPE.
Region-of-interest-based approach.
Segmentation-based approach.
BPE and breast cancer risk.
BPE and treatment outcomes.
Selective estrogen receptor modulator and aromatase inhibitor therapy.
Neoadjuvant chemotherapy, pCR, and RFS.MRI characteristics of common breast lesions.
MRI characteristics of benign lesions.Developmental abnormalities.
Fibroadenolipomas (hamartomas).
Lipomas.
Leiomyomas and hemangiomas.
Fibroadenomas.
Phyllodes tumor.
Cysts.
Fibrocystic changes.
Adenosis.
Infectious and inflammatory conditions.
Idiopathic granulomatous mastitis.
Pseudoangiomatous stromal hyperplasia.MRI characteristics of high-risk lesions.Histopathological characteristics.
Imaging findings at conventional imaging.
Imaging findings at breast MRI.
Management.
New frontiers.Further reading.
MRI characteristics of ductal carcinoma in situ.Clinical presentations and pathologic features of DCIS.
Appearance of DCIS on dynamic contrast-enhanced MRI.
DCIS appearance on advanced MRI techniques.
Diffusion-weighted imaging.
Ultrafast MRI.
MRI performance to assess the extent of DCIS.
Future directions: MRI to assess biology and prognosis.MRI characteristics of invasive breast cancer.Invasive ductal carcinoma.
Imaging presentation.
Invasive lobular carcinoma.
Imaging presentation.
Uncommon histologic subtypes of invasive breast cancer.
Mucinous carcinoma.
Tubular carcinoma.
Medullary carcinoma.
Papillary carcinoma.
Metaplastic carcinoma.
Special presentations of invasive breast cancer.
Paget disease of the breast.
Inflammatory breast cancer.Clinical indications for breast MRI.
Breast MRI for screening.Screening.
Early studies on screening for breast cancer with MRI.
The performance of MRI screening in women at increased risk.
Screening in specific risk groups.
BRCA1 and BRCA2.
Women with a history of radiation to the chest.
Other hereditary risk groups.
Familial risk.
Women with a personal history of breast cancer.
Women with high-risk lesion on biopsy.
Women with extremely or heterogeneously dense breasts.
Women at average risk.
Shortcomings of screening.
Undergoing the screening examination.
False-negative examinations.
False-positive screening examinations.
Overdiagnosis.
Additional screening methods for women undergoing breast MRI.
Clinical breast examination.
Ultrasound.
Mammography.
General guidance.Breast MRI for staging and treatment planning.
Introduction to the role of breast MRI.
MRI for staging.
Breast cancer staging overview.
Extent of disease.
Tumor size.
Locally advanced disease.
Multifocal, multicentric, and contralateral disease.
Nodal disease.
Metastatic disease.
Special situations.
Treatment planning.
Anatomic structures that impact treatment planning.
Ductal carcinoma in situ.
Invasive lobular carcinoma.
Molecular subtypes.
Impact of MRI on surgical outcomes.Neoadjuvant therapy response assessment with breast MRI.Pathologic measures of neoadjuvant therapy response.
Dynamic contrast-enhanced MRI, diffusion-weighted imaging, and MR spectroscopy: correlation with pathologic complete response.
Predicting response early in the course of therapy.
Diffusion-weighted imaging and response assessment.
MR spectroscopy.
Quantitative MRI metrics.
Ultrafast/accelerated breast MRI.
Monitoring chemotherapy response in the axilla.Breast MRI for post-treatment follow-up.Posttreatment changes.
Recurrent breast cancer.Breast augmentation and postmastectomy autologous breast reconstruction on breast MRI.Breast augmentation and implant-based reconstruction.
Breast implants.
Implant-based reconstruction.
Imaging evaluation of the breast after reconstructive surgery.
Imaging evaluation of the breast after primary augmentation.
MRI acquisition.
MRI-specific findings.
Normal findings.
Complications of implant-related surgery and findings on MRI.
Intracapsular rupture pitfalls and mimics.
Extracapsular rupture pitfalls and mimics.
Free silicone injection.
Free-fat injection, lipofilling, lipomodeling, or autologous fat grafting.
Autologous flaps.
Latissimus dorsi flap.
TRAM (transverse rectus abdominus muscle) flap.
DIEP (deep inferior epigastric perforator) flap.Problem-solving breast MRI.Evaluation of suspicious symptoms, including nipple discharge.
Nipple discharge.
Palpable lumps.
Breast pain.
Equivocal imaging findings.
Empirical evidence.
Masses.
Calcifications.
Architectural distortion.
Asymmetry.Imaging of the axilla and cancer of unknown primary.Anatomy of the axilla.
Spread of metastatic disease to axillary lymph nodes.
Evaluation of axillary lymph nodes.
MR imaging of the axilla.
Detection of abnormal axillary lymph nodes on MRI.
Clinical management of metastatic axillary lymph nodes.
Surgical approach: axillary lymph node dissection and sentinel lymph node biopsy.
Radiotherapy.
Chemotherapy.
The controversial role of imaging in axillary staging.
Role of MRI in the detection and treatment of occult primary breast cancer.
Interventional techniques for axillary lymph node localization and breast MRI.
Future directions.
Artificial intelligence-based axillary lymph node classification using breast MRI.Further reading.
Breast magnetic resonance imaging – guided interventions and therapy.
Biopsy, including MRI-directed US and rad-path correlation.History of MRI-guided techniques.
MRI-guided biopsy.
Imaging review.
Consent process, contraindications, and risk.
Equipment.
The procedure: positioning, protocol, percutaneous biopsy.
Positioning.
Protocol.
Percutaneous biopsy.
MRI localization.
MRI-guided clip placement with subsequent mammographic/sonographic localization.
MRI-directed skin localization with subsequent excisional biopsy.
MRI-guided wire localization.
Wire-free MRI localization.
MRI-directed ultrasound.
Radiologic – pathologic correlation.
Current challenges and future directions.MRI-guided minimally invasive therapy of breast lesions.State-of-the-art and methodologies.
Radiofrequency ablation.
Laser-induced thermal therapy.
High-intensity focused ultrasound.
Cryoablation.
Applications in breast care.
Current challenges and future directions.Future directions.
Advanced and emerging approaches.
Noncontrast MRI.Diffusion-weighted MRI.
DW MRI as a supplement to conventional DCE-MRI.
Cancer diagnosis.
Cancer prognosis.
Lymph node evaluation.
Cancer response to treatment.
DW MRI as a stand-alone modality.
DW MRI in screening settings.
Performance compared to other modalities.
Mammography.
DCE-MRI.
Abbreviated MRI.
Ultrasound.
False positives and negatives.
Image interpretation strategies.
Technical considerations.
B-value selection.
Emerging techniques.
Acquisition.
Postprocessing.
Advanced modeling.Metabolic imaging using ultra-high field MRI.Applications.
MRS/MRI applications.
1H MRS in the breast.
23Na MRI.
31 p. MRS.
CEST applications.
Chemical exchange saturation transfer.
Challenges and future applications.Quantitative DCE-MRI of the Breast.Pharmacokinetic modeling of DCE-MRI data.
Applications of quantitative breast DCE-MRI.
Characterizing breast cancer molecular subtypes and histopathological features.
Discriminating between malignant and benign breast lesions.
Predicting and evaluating breast cancer response to treatment.
Technical Considerations for Quantitative Breast DCE-MRI.
High temporal and high spatial resolution breast DCE-MRI.
Effect of water exchange and the shutter-speed PK model.
Breast DCE-MRI temporal resolution.
Breast DCE-MRI acquisition time.
AIF and R10 determinations for quantitative breast DCE-MRI.
PK model selection for breast DCE-MRI.Diffusion MRI of the breast: standard and advanced techniques.Diffusion-weighted imaging.
Principles of diffusion MRI.
Current status of DWI and ADC in clinical practice.
Differentiation between benign and malignant breast lesions.
Correlation with prognostic factors.
Therapeutic response.
“How to,” basic requirements, and the need for standardization.
Advanced diffusion MRI.
Intravoxel incoherent motion.
Principles.
Clinical value.
“How-to” and basic requirements.
Non-Gaussian diffusion.
Principles.
Common non-Gaussian diffusion approaches.
Diffusion Kurtosis Imaging.
Distributed diffusion models.
Restriction spectrum imaging.
Model-free approaches: sADC and S-index.
Combination of IVIM and non-Gaussian diffusion MRI.
Diffusion tensor imaging.
Principles.
Clinical value.MR spectroscopy.In vivo magnetic resonance spectroscopy technique.
Data analysis.
Clinical applications.
Differentiation of malignant and benign lesions using tCho levels.
Differentiation of malignant and benign lesions using lipid metabolites.
Determination of tumor aggressiveness and molecular subtypes.
Treatment response assessment.Emerging techniques in breast MRI.Ultrafast dynamic contrast-enhanced imaging.
Magnetic resonance elastography.
Magnetization transfer and chemical exchange saturation transfer.
Magnetic resonance spectroscopy.
Hyperpolarized [1-13C]-pyruvate.
MRI-constrained radiomics and habitat imaging.
MRI-constrained mathematical modeling.Hybrid imaging and alternative techniques.
PET/MRI hybrid imaging and targeted tracers.Radiotracers.
FDA-approved tracers.
Experimental tracers.
Acquisition protocol.
Breast 18F-FDG PET/MRI.
Whole-body 18F-FDG PET/MRI.
Clinical applications of 18F-FDG PET/MRI in breast cancer.
Breast cancer detection.
Breast cancer phenotyping.
Breast cancer staging.
Prediction/assessment of response to neoadjuvant chemotherapy.
New frontiers: radiomics and artificial intelligence.Competing and alternative techniques to breast MRI.
Contrast-enhanced mammography.Technique and reporting.
Diagnostic evaluation of screen-detected abnormalities and symptomatic patients.
CEM for staging.
CEM for disease monitoring post neoadjuvant chemotherapy.
CEM for screening.
Future directions.
Breast-specific gamma imaging and molecular breast imaging.Technique.
Screening and diagnostic evaluation.
Limitations.
Positron emission tomography and positron emission mammography of the breast.
Future directions.Prognostic and predictive MR imaging biomarkers.
MRI radiomics and radiogenomics for breast cancer.Image preprocessing.
Feature extraction.
Prognostic and predictive radiomic biomarkers for breast cancer.
Radiomic biomarkers to predict histopathologic and molecular subtype.
Radiomic biomarkers to predict overall and recurrence-free survival.
Radiomic biomarkers to predict therapy response.
Radiogenomics.
Correlations between radiomic signatures and gene expression status.
Correlations between radiomic signatures and biological pathways.
Combined radiogenomic models for outcome prediction.
Limitations and future directions.Breast imaging and deep learning: past, present, and future.Deep learning.
Segmentation.
Detection.
Lesion classification.
Risk prediction.
Treatment response.
Molecular subtypes.
Nodal status.
Pathologic complete response.
Considerations.