Breast MRI: State of the Art and Future Directions

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Breast MRI
Advances in Magnetic Resonance Technology and Applications Series
Breast MRI State of the Art and Future Directions
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Contents
Contributors
Preface
1 -
State of the art
	1 -
Performance and interpretation of breast MRI
		1 - Multiparametric breast MRI in clinical practice
			Introduction
			T1-weighted imaging
			Standard dynamic contrast-enhanced MRI
			T2-weighted imaging
			Diffusion-weighted imaging
			Other specific imaging sequences
			References
		2 - Abbreviated and Ultrafast MRI
			Introduction
			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
			Conclusions
			References
		3 - Artifacts in breast MRI
			Introduction
			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
			Conclusions
			References
		4 - Standard terminology and reporting– Breast Imaging Reporting & Data System: magnetic resonance imaging
			Introduction
			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
			Conclusions
			References
		5 - 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 analyses
			Conclusions
			References
		6 - Background parenchymal enhancement at breast MRI
			Introduction
			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
			Conclusions
			References
	2 -
MRI characteristics of common breast lesions
		7 - MRI characteristics of benign lesions
			Introduction
			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
			Conclusions
			References
		8 - MRI characteristics of high-risk lesions
			Introduction
			Histopathological characteristics
			Imaging findings at conventional imaging
			Imaging findings at breast MRI
			Management
			New frontiers
			References
			Further reading
		9 - MRI characteristics of ductal carcinoma in situ
			Introduction
			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
			Conclusions
			References
		10 - MRI characteristics of invasive breast cancer
			Introduction
			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
			Conclusions
			References
	3: Clinical indications for breast MRI
		11 - Breast MRI for screening
			Introduction
				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
			References
		12 - 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
			Conclusions
			References
		13 - Neoadjuvant therapy response assessment with breast MRI
			Introduction
			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
			Conclusions
			References
		14 - Breast MRI for post-treatment follow-up
			Introduction
			Posttreatment changes
			Recurrent breast cancer
			References
		15 - Breast augmentation and postmastectomy autologous breast reconstruction on breast MRI
			Introduction
			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
			References
		16 - Problem-solving breast MRI
			Introduction
			Evaluation of suspicious symptoms, including nipple discharge
				Nipple discharge
				Palpable lumps
				Breast pain
			Equivocal imaging findings
				Empirical evidence
				Masses
				Calcifications
				Architectural distortion
				Asymmetry
			Conclusions
			References
		17 - Imaging of the axilla and cancer of unknown primary
			Introduction
			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
			Conclusions
			References
			Further reading
	4 -
Breast magnetic resonance imaging–guided interventions and therapy
		18 - Biopsy, including MRI-directed US and rad-path correlation
			Introduction
			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
			Conclusions
			References
		19 - MRI-guided minimally invasive therapy of breast lesions
			Introduction
			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
			Conclusions
			References
2 -
Future directions
	5 -
Advanced and emerging approaches
		20
 - Noncontrast MRI
			Introduction
			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
			Conclusions
			References
		21 - Metabolic imaging using ultra-high field MRI
			Introduction
			Applications
				MRS/MRI applications
					1H MRS in the breast
					23Na MRI
					31P MRS
				CEST applications
					Chemical exchange saturation transfer
			Challenges and future applications
			Conclusions
			References
		22 - Quantitative DCE-MRI of the Breast
			Introduction
			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
			Conclusions
			References
		23 - Diffusion MRI of the breast: standard and advanced techniques
			Introduction
			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
			Conclusions
			References
		24 - MR spectroscopy
			Introduction
			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
			Conclusions
			References
		25 - Emerging techniques in breast MRI
			Introduction
			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
			Conclusions
			References
	6 - Hybrid imaging and alternative techniques
		26 - PET/MRI hybrid imaging and targeted tracers
			Introduction
			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
			Conclusions
			References
		27 - Competing and alternative techniques to breast MRI
			Contrast-enhanced mammography
				Background
				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
				Background
				Technique
				Screening and diagnostic evaluation
				Limitations
			Positron emission tomography and positron emission mammography of the breast
			Future directions
			References
	7 -
Prognostic and predictive MR imaging biomarkers
		28 - MRI radiomics and radiogenomics for breast cancer
			Introduction
			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
			References
		29 - Breast imaging and deep learning: past, present, and future
			Introduction
			Deep learning
			Segmentation
			Detection
			Lesion classification
			Risk prediction
			Treatment response
			Molecular subtypes
			Nodal status
			Pathologic complete response
			Considerations
			Conclusions
			References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
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