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Assessment of Suspected Breast Cancer by MRI: A Prospective Clinical Trial Using a Combined Kinetic and Morphologic Analysis

Jonathan I. Wiener1, Kathy J. Schilling1, Carol Adami1 and Nancy A. Obuchowski2

1 Department of Radiology, Boca Raton Community Hospital, 800 Meadows Rd., Boca Raton, FL 33486.
2 Department of Biostatistics and Epidemiology, The Cleveland Clinic, Cleveland, OH.



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Fig. 1A. —72-year-old woman with breast cancer. Whole-volume maximum-intensity-projection image shows typical bilateral infiltrating ductal breast cancers with spiculated margins.

 


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Fig. 1B. —72-year-old woman with breast cancer. Kinetic color map of right breast shows lesion contains extensive areas of bright yellow.

 


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Fig. 1C. —72-year-old woman with breast cancer. Graph of single voxel from lesion shown in color in B indicates relative enhancement of greater than 200% on first postcontrast time point and significant drop in signal on subsequent time points.

 


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Fig. 1D. —72-year-old woman with breast cancer. Kinetic color map of mammographically occult left breast lesion shows this lesion also has malignant enhancement curves with central yellow regions and outer rim of reds and pinks.

 


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Fig. 1E. —72-year-old woman with breast cancer. Graph of single voxel from lesion shown in color in D exhibits pink color that indicates relative enhancement on first time point of greater than 100%, with greater than 20% relative washout on last time point.

 


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Fig. 2. —46-year-old woman with fibroadenoma. Kinetic color map shows fibroadenoma has progressive enhancement curve, which is shown in orange. Note motion artifact along skin surface.

 


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Fig. 3A. —Standard (A) and magnified (B) mammograms obtained in 57-year-old woman with heterogeneously dense breasts show palpable mass in right outer breast. Mediolateral oblique (A) and craniocaudal (B) views from mammograms fail to reveal discrete mass.

 


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Fig. 3B. —Standard (A) and magnified (B) mammograms obtained in 57-year-old woman with heterogeneously dense breasts show palpable mass in right outer breast. Mediolateral oblique (A) and craniocaudal (B) views from mammograms fail to reveal discrete mass.

 


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Fig. 3C. —Standard (A) and magnified (B) mammograms obtained in 57-year-old woman with heterogeneously dense breasts show palpable mass in right outer breast. Targeted sonogram confirms 2-cm suspicious mass in upper outer breast.

 


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Fig. 3D. —Standard (A) and magnified (B) mammograms obtained in 57-year-old woman with heterogeneously dense breasts show palpable mass in right outer breast. Targeted sonogram confirms finding on MR image (not shown): second 1.5-cm irregular mass with typical malignant enhancement curves in upper inner quadrant. This lesion and lesion shown in C were subsequently biopsied under sonographic guidance. Patient then required mastectomy for two infiltrating ductal carcinomas and surrounding ductal carcinoma in situ.

 

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