Does Hypervascularity of Liver Metastases as Detected on MRI Predict Disease Progression in Breast Cancer Patients?
Larissa Braga1,
Richard C. Semelka1,
Ricardo Pietrobon2,
Diego Martin3,4,
Nestor de Barros5 and
Ulrich Guller6
1 Department of Radiology, University of North Carolina at Chapel Hill, Manning
Dr., Chapel Hill, NC 27599-7510.
2 Center for Excellence in Surgical Outcomes, Duke University Medical Center,
Durham, NC.
3 Department of Radiology, West Virginia University, Morgantown, WV.
4 Present address: Department of Radiology, Emory University, 1365 Clifton Rd.
NE, Bldg. A, Ste. 622, Atlanta, GA 30322.
5 Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil.
6 Department of Surgery, Divisions of General Surgery and Surgical Research,
University Hospital Basel, Basel, Switzerland.
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Fig. 1A. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Baseline unenhanced transverse T1-weighted
spoiled gradient-echo image (TR/TE, 150/4.1) shows metastasis (arrow)
with moderately low signal intensity in liver segment VI.
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Fig. 1B. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Baseline contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(B), 45 sec (C), and 90 sec (D) after administration of
contrast material. Faint ring lesion enhancement is less intense than
enhancement of renal cortex and pancreas on immediate contrast-enhanced image
(B). Note that lesion becomes more conspicuous at 45- and 90-sec images
(C, D), which is characteristic of hypovascular metastases.
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Fig. 1C. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Baseline contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(B), 45 sec (C), and 90 sec (D) after administration of
contrast material. Faint ring lesion enhancement is less intense than
enhancement of renal cortex and pancreas on immediate contrast-enhanced image
(B). Note that lesion becomes more conspicuous at 45- and 90-sec images
(C, D), which is characteristic of hypovascular metastases.
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Fig. 1D. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Baseline contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(B), 45 sec (C), and 90 sec (D) after administration of
contrast material. Faint ring lesion enhancement is less intense than
enhancement of renal cortex and pancreas on immediate contrast-enhanced image
(B). Note that lesion becomes more conspicuous at 45- and 90-sec images
(C, D), which is characteristic of hypovascular metastases.
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Fig. 1E. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Follow-up unenhanced transverse T1-weighted
spoiled gradient-echo image (150/4.1) after 5 months reveals no change in
lesion size (arrow) compared with previous examination
(A).
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Fig. 1F. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Follow-up contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(F), 45 sec (G), and 90 sec (H) after administration of
contrast material. Again, lesion enhancement is less intense than that of
renal cortex and pancreas on immediate contrast-enhanced image (F) and
more conspicuous on 90-sec image (H).
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Fig. 1G. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Follow-up contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(F), 45 sec (G), and 90 sec (H) after administration of
contrast material. Again, lesion enhancement is less intense than that of
renal cortex and pancreas on immediate contrast-enhanced image (F) and
more conspicuous on 90-sec image (H).
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Fig. 1H. —62-year-old woman with hypovascular liver metastases from
breast cancer and stable disease. Follow-up contrast-enhanced transverse
T1-weighted spoiled gradient-echo images (150/4.1) were obtained immediately
(F), 45 sec (G), and 90 sec (H) after administration of
contrast material. Again, lesion enhancement is less intense than that of
renal cortex and pancreas on immediate contrast-enhanced image (F) and
more conspicuous on 90-sec image (H).
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Fig. 2A. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. Baseline unenhanced
transverse T1-weighted spoiled gradient-echo image (TR/TE, 150/4.1) shows two
metastases (arrows) of slightly low signal intensity in liver
segments V and VI.
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Fig. 2B. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. Baseline
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (B), 45 sec (C), and 90 sec
(D) after administration of contrast material. One lesion presents
intense enhancement similar to that of renal cortex and pancreas on immediate
contrast-enhanced image (arrow, B). Other lesion (segment V)
does not enhance intensely. At 90 sec, both lesions become less conspicuous
than on immediate contrast-enhanced image, which is characteristic of
hypervascular metastases.
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Fig. 2C. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. Baseline
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (B), 45 sec (C), and 90 sec
(D) after administration of contrast material. One lesion presents
intense enhancement similar to that of renal cortex and pancreas on immediate
contrast-enhanced image (arrow, B). Other lesion (segment V)
does not enhance intensely. At 90 sec, both lesions become less conspicuous
than on immediate contrast-enhanced image, which is characteristic of
hypervascular metastases.
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Fig. 2D. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. Baseline
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (B), 45 sec (C), and 90 sec
(D) after administration of contrast material. One lesion presents
intense enhancement similar to that of renal cortex and pancreas on immediate
contrast-enhanced image (arrow, B). Other lesion (segment V)
does not enhance intensely. At 90 sec, both lesions become less conspicuous
than on immediate contrast-enhanced image, which is characteristic of
hypervascular metastases.
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Fig. 2E. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 4-month follow-up,
unenhanced transverse T1-weighted spoiled gradient-echo image (150/4.1)
reveals increase in size of metastases (arrows) compared with
previous examination (A).
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Fig. 2F. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 4-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (F), 45 sec (G), and 90 sec
(H) after administration of contrast material. Lesions enhance avidly
(F), similar to enhancement of renal cortex and pancreas on immediate
contrast-enhanced image. At 90 sec, lesions are less conspicuous than on
immediate and 45-sec images.
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Fig. 2G. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 4-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (F), 45 sec (G), and 90 sec
(H) after administration of contrast material. Lesions enhance avidly
(F), similar to enhancement of renal cortex and pancreas on immediate
contrast-enhanced image. At 90 sec, lesions are less conspicuous than on
immediate and 45-sec images.
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Fig. 2H. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 4-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (F), 45 sec (G), and 90 sec
(H) after administration of contrast material. Lesions enhance avidly
(F), similar to enhancement of renal cortex and pancreas on immediate
contrast-enhanced image. At 90 sec, lesions are less conspicuous than on
immediate and 45-sec images.
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Fig. 2I. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 6.5-month follow-up,
unenhanced transverse T1-weighted spoiled gradient-echo image (150/4.1) shows
appearance of new lesion (not shown, different level) and slight increase in
size in preexisting lesions (arrows).
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Fig. 2J. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 6.5-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (J), 45 sec (K), and 90 sec
(L) after administration of contrast material. On immediate image, one
lesion shows intense enhancement (arrow, J) but other shows
faint enhancement (arrowhead, J). At 90 sec, lesion showing
intense enhancement in immediate image is less conspicuous. Conversely, lesion
(arrowhead, L) that exhibits faint enhancement in immediate
image is now more conspicuous.
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Fig. 2K. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 6.5-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (J), 45 sec (K), and 90 sec
(L) after administration of contrast material. On immediate image, one
lesion shows intense enhancement (arrow, J) but other shows
faint enhancement (arrowhead, J). At 90 sec, lesion showing
intense enhancement in immediate image is less conspicuous. Conversely, lesion
(arrowhead, L) that exhibits faint enhancement in immediate
image is now more conspicuous.
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Fig. 2L. —52-year-old woman with predominantly hypervascular liver
metastases from breast cancer and progressive disease. At 6.5-month follow-up,
contrast-enhanced transverse T1-weighted spoiled gradient-echo images
(150/4.1) were obtained immediately (J), 45 sec (K), and 90 sec
(L) after administration of contrast material. On immediate image, one
lesion shows intense enhancement (arrow, J) but other shows
faint enhancement (arrowhead, J). At 90 sec, lesion showing
intense enhancement in immediate image is less conspicuous. Conversely, lesion
(arrowhead, L) that exhibits faint enhancement in immediate
image is now more conspicuous.
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Copyright © 2004 by the American Roentgen Ray Society.
