Hanan Sherif MD, Presenter: Nothing to Disclose

Ahmed-Emad Mahfouz MD, Abstract Co-Author: Nothing to Disclose

Ahmed El Sayed Sayedin MBBCh, Abstract Co-Author: Nothing to Disclose

Aalaa Salaheldin Kambal MBBS, Abstract Co-Author: Nothing to Disclose

Imaad Bin Mujeeb MD, Abstract Co-Author: Nothing to Disclose

To evaluate 3-D fused gadolinium-enhanced and diffusion-weighted images in preoperative assessment of multicentricity, multifocality, and bilaterality in patients with breast carcinoma

72 patients with biopsy-proven breast carcinoma have been sent to MR imaging for preoperative assessment of multicentricity, multifocality, and bilaterality. Based on mastectomy/ lumpectomy specimens, 47 patients had single lesions. 12 multicentric , 10 multifocal, and 3 bilateral carcinoma with a total number of 116 proven malignant foci. The preoperative MR images were post-processed on an advanced workstation to obtain 3D fused images of the unenhanced breast parenchyma, early gadolinium enhancement (coded red), and diffusion-weighted images with b=1500 s/mm2(coded green). To eliminate the T2-shine-through effect, lesions with ADC ≥ 1× 10−3 mm 2 /s were eliminated. The post-processed images were reviewed by an experienced radiologist, blinded to the histopathology, who noted all the lesions with a diameter ≥ 5 mm classifying them into three groups: matched enhancement and diffusion restriction, unmatched diffusion restriction, and unmatched enhancement.

313 Lesions with a diameter ≥ 5 mm have been identified. 101 lesions showed matched enhancement and difusion restriction. Taking matched lesions as indicative of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of malignant foci have been 84.5, 98.5, 97, 91, and 93.3 % respectively. Three false positive foci of matched E-DR were due to fibroadenomas. 18 false negative foci have been due to foci of DCIS less than 1 cm in diameter. The method correctly identified all cases of bilaterality and multifocality, Three patients with multicenteric malignancy were diagnosed as individual lesion. Three patients with multicentricity were diagnosed as multifocal because of fibroadenomas. Three patients were correctly classified as multicentric with underestimated number of foci.

Fused gadolinium-enhanced and diffusion-weighted MR images of the breast offer a reasonably accurate assessment of bilaterality, multifocality, and multicentricity in patients with breast carcinoma.

The technique may be useful in patients with breast carcinoma suspected to have multiple lesions. The 3D and color coded images are easy to read and optimal to use by the surgeon for surgical planning.

Sherif, H, Mahfouz, A, El Sayed Sayedin, A, Kambal, A, Bin Mujeeb, I, Three-dimensional Fused Images of Gadolinium Enhancement and Diffusion Restriction: Value in Preoperative Determination of Multifocality, Multicentricity, and Bilaterality of Breast Carcinoma.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017650.html