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
Priv.-Doz., Dr. med., Dipl.-Chem. Werner A. Kaiser Radiologische Universitatsklinik Sigmund-Freud-Strasse 25/20 5300 Bonn, FRG ISBN-13: 978-3-642-77258-0 001: 10.1007/978-3-642-77256-6 e-isbn-13: 978-3-642-77256-6 Library of Congress Cataloging-in-Publication Data. Kaiser, Werner A., 1949- MR mammography (MRM) 1 Werner A. Kaiser. p. em. Includes bibliographical references and index. ISBN-13: 978-3-642-77258-0 1. 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.M33K35 1992 616.99'24907548-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 21/3130-54321 0 - Printed on acid-free paper
Contents 1 Introduction. 1 2 Basic Concepts. 3 2.1 Basic Principles of MRI. 3 2.1.1 Design of a Magnetic Resonance Unit. 6 2.1.2 Radiofrequency Coils. 6 2.1.3 Basic Conduct of the MRM Examination 7 2.2 Contrast Media in MRI. 8 2.3 Medical Significance of Breast Tumors. 9 2.4 Breast Imaging Modalities. 16 2.4.1 X-Ray Mammography 16 2.4.2 Sonography. 20 2.4.3 Thermography 21 2.4.4 Computed Tomography. 22 2.4.5 Angiography. 22 3 Brief Review of the Development of Magnetic Resonance Mammography 23 3.1 Development of MRM 23 3.2 Present Investigations. 24 4 Present Indications for MRM 27 5 Optimum Procedure for the MRM Examination. 29 5.1 History. 29 5.2 Procedure. 29 5.3 Problems and Sources of Error in MRM. 31 5.3.1 Problems of Patient Selection. 31 5.3.2 Problems of Positioning. 32 5.3.3 Problems of Imaging 32 5.3.4 Errors in Injecting the Contrast Medium. 34 5.3.5 Errors of Image Interpretation 34 6 Clinical Aspects 37 6.1 General Criteria for Image Interpretation. 37 6.2 The Normal Breast 38 6.3 Carcinoma 42 6.4 Fibroadenoma. 52
VI Contents 6.5 Cysts. 58 6.6 Scars. 59 6.7 Mastopathies 62 6.8 Special Cases 66 6.8.1 Status After Plastic Surgery 66 6.8.2 Inflammatory Carcinoma, Mastitis 67 6.8.3 Nipple and Skin Changes 67 6.8.4 Status After Irradiation. 68 6.8.5 Postoperative Complications. 72 6.8.6 Lactating Breast. 77 6.8.7 Breast Diseases in Males 81 6.8.8 Apocrine Carcinoma 84 6.8.9 Cystosarcoma Phylloides 84 6.9 Comparison of the Results of MRM and X-Ray Mammography 87 7 Teaching Examples. 89 8 Interpretation 343 8.1 General. 343 8.2 The Normal Breast. 345 8.3 Carcinoma 346 8.4 Fibroadenoma. 349 8.5 Cysts. 349 8.6 Mastopathies 349 8.7 Scars. 350 8.8 Lactating Breast 350 8.9 Comparison of MRM Results with X-Ray Mammography 351 8.10 Future Outlook 351 9 Summary. 353 Appendix: Research on the Development and Optimization of the Examination Technique.... 355 A.1 MRI Equipment...... 355 A.2 Coils for Breast Examination. 355 A.2.1 Coil Development..... 355 A.2.2 Comparison of Three Different Breast Coils 358 A.3 Examination Parameters...... 362 A.4 Spin-Echo Examination Technique. 363 A.5 Gradient-Echo Sequences: Test Phase 366 A.6 Dynamic Examinations...... 374 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
Contents VII A.10 A.10.1 A.10.2 Spectroscopic Examinations 31 P NMR Spectroscopy. 1 H NMR Spectroscopy 396 396 396 Acknowledgment. References Subject Index 401 403 415