Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions Sibel Kul1 Aysegül Cansu1 Etem Alhan2 Hasan Dinc1 Abdulkadir Reis3 Gamze Çan4 Kul S, Cansu A, Alhan E, Dinc H, Reis A, Çan G 1Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. Address correspondence to S. Kul (firstname.lastname@example.org). 2Department of General Surgery. Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 3 Department of Pathology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 4 Department of Public Health, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
AJR 2010; 195:1250–1254 0361–803X/10/1955–1250 © American Roentgen Ray Society
MRI is the most accurate method of detection of invasive breast cancer, having nearly 100% sensitivity. The specificity, however, is only moderate (72% overall specificity in 44 studies) and varies widely across studies of the diagnostic performance of breast MRI related to cancer prevalence and the criteria used to differentiate malignant and benign lesions . Developments in MRI systems, image acquisition protocols, and image interpretation methods are continuing to improve specificity. The results of previous studies have shown an association between breast cancer and ipsilateral increased blood flow at laser Doppler imaging  and PET . It is possible to obtain MR angiograms of the breast with postprocessing of 3D dynamic contrast-enhanced MR images. Maximum-intensity-projection (MIP) reconstruction of subtracted dynamic MR images shows enhancing lesions and the breast vasculature at the same time. Increased vascularity adjacent to breast cancer lesions and in the ipsilateral breast as a whole has been found Keywords: breast, contrast-enhanced MRI, MR angiography, MRI, vascularity DOI:10.2214/AJR.10.4368
Received January 28, 2010; accepted after revision March 25, 2010. W O M E N ’ S I M A G I N G
The purpose of this study was to investigate the role of evaluation of breast vascularity with contrast-enhanced MR angiography in the differentiation of malignant from benign lesions.
Contrast-enhanced 3D MR angiograms of the breasts of 102 patients with unilateral and histopathologically confirmed breast lesions were evaluated retrospectively. All images were evaluated for both ipsilateral increased vascularity and adjacent vessel sign, and the values of these signs in the diagnosis of malignancy were assessed.
Histopathologic analysis of 102 patients revealed 50 malignant and 52 benign results. In 31 of the 50 patients with breast cancer and in 11 of the 52 patients with benign lesions, ipsilateral breast vascularity was increased. The resulting sensitivity and specificity of ipsilateral increased vascularity were 62% and 79%. The adjacent vessel sign was present in 37 of the 50 patients with breast cancer and six of the 50 patients with benign lesions. The resulting sensitivity and specificity of the adjacent vessel sign were 74% and 89%. The overall accuracies of ipsilateral increased vascularity and the adjacent vessel sign were 71% and 81%.
Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043).