MR Mammography (MRM) Werner A. Kaiser. Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

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2 Werner A. Kaiser MR Mammography (MRM) With 648 Figures and 25 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

3 Priv.-Doz., Dr. med., Dipl.-Chem. Werner A. Kaiser Radiologische Universitatsklinik Sigmund-Freud-Strasse 25/ Bonn, FRG ISBN-13: : / e-isbn-13: Library of Congress Cataloging-in-Publication Data. Kaiser, Werner A., MR mammography (MRM) 1 Werner A. Kaiser. p. em. Includes bibliographical references and index. ISBN-13: Breast-Magnetic resonance imaging. I. Title. [DNLM: 1. Breast Diseases-radiography. 2. Breast Neoplasms-radiography. 3. Magnetic Resonance Imaging-methods. 4. Mammography. WP 815 K13m] RG493.5.M33K ' dc20 DNLM/DLC This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitating, broadcasting, reproduction on microfilm or in any other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9,1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. Springer-Verlag Berlin Heidelberg 1993 Softcover reprint of the hardcover 1 st edition 1993 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Layout and production supervision: W. Bischoff, Heidelberg Cover design: Struwe & Partner, Heidelberg 21/ Printed on acid-free paper

4 Contents 1 Introduction. 1 2 Basic Concepts Basic Principles of MRI Design of a Magnetic Resonance Unit Radiofrequency Coils Basic Conduct of the MRM Examination Contrast Media in MRI Medical Significance of Breast Tumors Breast Imaging Modalities X-Ray Mammography Sonography Thermography Computed Tomography Angiography Brief Review of the Development of Magnetic Resonance Mammography Development of MRM Present Investigations Present Indications for MRM 27 5 Optimum Procedure for the MRM Examination History Procedure Problems and Sources of Error in MRM Problems of Patient Selection Problems of Positioning Problems of Imaging Errors in Injecting the Contrast Medium Errors of Image Interpretation 34 6 Clinical Aspects General Criteria for Image Interpretation The Normal Breast Carcinoma Fibroadenoma. 52

5 VI Contents 6.5 Cysts Scars Mastopathies Special Cases Status After Plastic Surgery Inflammatory Carcinoma, Mastitis Nipple and Skin Changes Status After Irradiation Postoperative Complications Lactating Breast Breast Diseases in Males Apocrine Carcinoma Cystosarcoma Phylloides Comparison of the Results of MRM and X-Ray Mammography 87 7 Teaching Examples Interpretation General The Normal Breast Carcinoma Fibroadenoma Cysts Mastopathies Scars Lactating Breast Comparison of MRM Results with X-Ray Mammography Future Outlook Summary. 353 Appendix: Research on the Development and Optimization of the Examination Technique A.1 MRI Equipment A.2 Coils for Breast Examination. 355 A.2.1 Coil Development A.2.2 Comparison of Three Different Breast Coils 358 A.3 Examination Parameters A.4 Spin-Echo Examination Technique. 363 A.5 Gradient-Echo Sequences: Test Phase 366 A.6 Dynamic Examinations A.7 3D-Dynamic Gradient-Echo Examinations. 378 A.8 In Vitro Studies of MR Contrast Enhancement 383 A.9 Two-Dimensional Multislice FLASH Sequence 389

6 Contents VII A.10 A.10.1 A.10.2 Spectroscopic Examinations 31 P NMR Spectroscopy. 1 H NMR Spectroscopy Acknowledgment. References Subject Index