Variation in Technical Quality of Breast MRI

Updated breast MRI lexicon

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Background: Radiology and oncology clinical guidelines recommend that people with high-risk of breast cancer should be offered screening with magnetic resonance imaging (MRI). Rates of appropriate screening remain low, which could also be related to patient awareness and knowledge about optimal screening modalities/schedules. Appropriate screening is even more critical for African-American women, in whom there are higher rates of genetic mutations (e.g., BRCA) conferring a greater risk of high-risk breast cancer. Southern United States (US) states have a higher proportion of African-American women. We sought to explore the availability of information on high-risk breast cancer screening using breast MRI across the websites of the top 20 cancer centers in the US (as per US News data) as well as the top US News cancer center in each of 5 representative southern US states where the average annual breast cancer-related death rate is greater than 20 per 100,000 people, age adjusted to the 2000 US standard population. Methods:We utilized publicly available data from the 2020-2021 US News website to identify top 20 cancer centers. We performed a google search using two separate keyword phrases (“high-risk breast cancer screening” and “breast MRI”), and the name of the cancer center. US News 2020-21 online ranking data was also used to identify the top cancer center in each of the five representative US states (Alabama, Georgia, Louisiana, Mississippi and South Carolina) and a similar search methodology was adopted for these five cancer centers. We then reviewed each cancer center’s website(s) and webpages to ascertain the availability of information regarding the availability of specific high-risk breast cancer clinic/programs and specific information on screening with breast MRI. Results: Of the top 20 US cancer centers, 15 (75%) have an established high-risk breast cancer clinic/program per their website. Two (2/15) of these cancer centers only had a general high-risk cancer assessment/genetics clinic and two (2/15) had no additional information available about the high-risk clinics. Information on high-risk factors was available on 12/20 (60%) websites. Seventeen centers (85%) included information on breast MRI, but only 8 (40%) had patient-centered detailed information on breast MRI for high-risk patients and 4 (20%) centers included an online, personalized, risk assessment tool. Among the top cancer center in each of the 5 representative Southern states, only 1 (20%) had information regarding a high-risk breast cancer evaluation program. While 4 (80%) had information on breast MRI information, there was no specific information available for high risk screening. Conclusions: These findings underscore the unmet need of easy access to online information from the websites of the top cancer centers nationally as well as the top state level cancer centers in the five representative southern US states for women with high risk of developing breast cancer. These limitations are particularly relevant for African-American women living in the South. Limitations of this study include the cross-sectional assessment of online data and that discrepancies may exist between websites and actual availability of clinical services. Citation Format: Jaspreet Singh Batra, Elizabeth Park, Arjun Gupta. Information availability about screening for high-risk breast cancer on cancer center websites [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-04-01.

To compare the effects of gadoxetic acid and gadoteric acid on the image quality of single-breath-hold, triple (first, second, and third) arterial hepatic magnetic resonance imaging (MRI). Two hundred and eleven patients were divided into two groups according to the contrast materials used (gadoxetic acid, 108 patients and gadoteric acid, 103 patients). All 3.0-T MR examinations included triple arterial phase acquisition using the 4D enhanced T1-weighted high-resolution isotropic volume examination (eTHRIVE) keyhole technique. The image qualities of the pre-contrast and triple arterial phases were assessed in terms of image artifacts, sharpness of the intrahepatic vessel and liver edge, and overall image quality with a 5-point scale for qualitative analysis. The image quality of gadoxetic acid-enhanced liver MRI in the triple arterial phases was significantly degraded compared with that of gadoteric acid-enhanced liver MRI, although better image scores were observed in the pre-contrastimages in the gadoxetic acid group (P < 0.001). The overall image quality gradually improved from the first to the third arterial phases in both groups (P < 0.003). Intravenous gadoxetic acid could have a detrimental effect on image quality of triple arterial phase MRI with the 4D eTHRIVE Keyhole technique. The third arterial phase images had the best image qualities; thus, they could be used as key scans.

We aimed to investigate the value of breast magnetic resonance (MR) imaging and positron emission tomography-computed tomography (PET/CT) in predicting advanced axillary lymph node (ALN) metastases (ypN2-3) after neoadjuvant chemotherapy (NAC) in invasive ductal carcinoma patients. A total of 108 patients with invasive ductal carcinoma underwent breast MR imaging and PET/CT both before and after NAC (termed initial staging and restaging, respectively). The number of positive ALNs and the short diameter (SD) of the largest ALN on breast MR imaging and maximal standardized uptake value (SUVmax) in the ALNs on PET/CT were evaluated. Odds ratio (OR) for prediction of advanced ALN metastases was calculated. The negative predictive value (NPV) of restaging imaging for exclusion of advanced ALN metastases was also calculated. Patients with advanced ALN metastases were more likely to have a higher number (≥2) of positive LNs (OR, 8.06; P = 0.015) on restaging MR imaging. No clinico-pathological factors were significantly associated with advanced ALN metastases. With restaging MR imaging, PET/CT, and MR imaging plus PET/CT, the NPV for excluding advanced ALN metastases was 97.3%, 94.4%, and 100.0%. A higher number of positive ALNs on restaging MR imaging was an independent predictor for advanced ALN metastases after NAC.

Standard terminology and reporting– Breast Imaging Reporting &amp; Data System: magnetic resonance imaging

Magnetic Resonance Imaging (MRI) plays a role in demonstrating substantial utility in lung lesion imaging, detection, diagnosis, and evaluation. Previous studies have found that free-breathing star VIBE sequences not only have high image quality but also have a high ability to detect and display nodules. However, in our routine clinical practice, we have encountered suboptimal image quality in the free-breathing sequences of certain patients. This study aims to assess the impact of breath training on the quality of chest magnetic resonance imaging obtained during free-breathing sequences. A total of 68 patients with lung lesions, such as nodules or masses detected via Computed Tomography (CT) examination, were prospectively gathered. They were then randomly divided into two groups: an observation group and a control group. Standard preparation was performed for all patients in both groups before the examination. The observation group underwent 30 minutes of breath training prior to the MRI examination additionally, followed by the acquisition of MRI free-breathing sequence images. The signal intensity (SI) and standard deviation (SD) of the lesion and adjacent normal lung tissue were measured, and the image signal-to-noise ratio (SNR) and contrast signal-to-noise ratio (CNR) of the lesion were calculated for objective image quality evaluation. The subjective image quality of the two groups of images was also evaluated using a 5-point method. MRI examinations were completed in both groups. Significantly better subjective image quality (edge and internal structure clarity, vascular clarity, breathing and cardiac artifacts, and overall image quality) was achieved in the observation group compared to the control group (P<0.05). In addition, higher SNR and CNR values for disease lesions were observed in the observation group compared to the control group (t=4.35, P<0.05; t=5.35, P<0.05). It is concluded that the image quality of free-breathing sequences MRI can be improved through breath training before examination.

Background: To obtain magnetic resonance (MR) images of good quality for accurate target localization in deep brain stimulation (DBS) surgery, sedation or anesthesia may be used, although their usefulness has not been proven. Objective: To assess whether sedation or general anesthesia (GA) improve the quality of MR imaging (MRI). Methods: The records of DBS procedures for Parkinson’s disease (PD), dystonia, and essential tremor in our tertiary neurosurgical unit between January 2011 and June 2016 were reviewed. Adult patients with preoperative MR images were included. Patient records concerning MRI, surgery, adverse events, and clinical outcome were retrospectively scrutinized and analyzed. MR image quality was assessed by two independent radiologists. Results: A total of 215 preoperative MR images for 177 DBS procedures were analyzed. The MRI sequences performed under GA were superior to those performed without anesthesia or under sedation (p < 0.01). Virtually all images captured under GA were of good quality, while the proportions among those captured with sedation or without anesthesia were <65%. Good image quality was not associated with better clinical outcome (>50% improvement in the Unified Parkinson’s Disease Rating Scale III score) among patients with PD. Conclusion: GA was associated with better MRI sequences than intravenous sedation or no anesthesia.

Breast magnetic resonance (MR) imaging, because of its extremely high sensitivity in detecting invasive breast cancers, is sometimes used as a diagnostic tool to evaluate equivocal mammographic findings. However, breast MR imaging should never substitute for a complete diagnostic evaluation or for biopsy of suspected, localizable suspicious mammographic lesions, whenever possible. The modality's high cost, in addition to only moderate specificity, mandate that radiologists use it sparingly and with discrimination for problematic mammographic findings. It is rare that the reality or significance of a noncalcified mammographic finding remains equivocal or problematic at diagnostic mammography evaluation, which usually includes targeted ultrasonography (US). There are several reasons for this infrequent occurrence: (a) an asymmetry may persist on diagnostic views but be visible only on craniocaudal or mediolateral oblique projections, precluding three-dimensional localization for US or biopsy, or a lesion may persist on some diagnostic spot views but dissipate or efface on others; (b) uncertainty may exist as to whether apparent change is clinically important or owing to technical factors such as compression or positioning differences; or (c) a lesion may be suspected but biopsy options are limited owing to lack of a US correlate and lesion inaccessibility for stereotactic biopsy, or biopsy of a vague or questionably real lesion has been attempted unsuccessfully. This article will discuss the indications for problem-solving MR imaging for equivocal mammographic findings, present cases illustrating appropriate and inappropriate uses of problem-solving MR imaging, and present false-positive and false-negative cases affecting the specificity of breast MR imaging. (©)RSNA, 2016.

The American College of Radiology's (ACR) Nuclear Medicine and PET Accreditation Programs evaluate qualifications of personnel, equipment, image quality, and quality control measures. It is believed that these are primary factors that impact the quality of patient imaging. The ACR accreditation allows facilities to critique and improve their practices as part of their preparation for the accreditation evaluation process. The goals of the ACR Nuclear Medicine and PET Accreditation Programs are improvement in the quality of imaging, provision of educational information by raising awareness of imaging issues, and the recognition of imaging facilities which meet program objectives. This presentation will outline the program requirements, highlighting some of the common pitfalls that may cause deficiencies in both the clinical and phantom submissions.This presentation will provide participants with:1. General information describing the ACR Accreditation Programs2. Information about the Diagnostic Modality Accreditation Programs3. Specific information about the ACR Nuclear Medicine and PET Accreditation Program, to include the application process, clinical images submission and quality control requirements.

BackgroundThe diagnostic accuracy of prostate magnetic resonance imaging (MRI) is highly dependent on image quality. Although the effects of spasmolytics and rectal preparation have been previously studied, the findings remain inconsistent and fail to address other critical modifiable factors. This study aimed to evaluate the impact of various modifiable factors on prostate MRI image quality and their subsequent influence on Prostate Imaging Reporting and Data System (PI-RADS) scoring.MethodsFifty-six consecutive patients who underwent 3T multiparametric MRI (mpMRI) with the administration of hyoscine butylbromide (HB+) and at least one 3T mpMRI without HB (HB−) ≤3 years earlier were retrospectively evaluated. Two radiologists performed morphometry of the prostate, bladder, rectum, and abdomen and evaluated image quality, artifacts, and motion on a five-point scale and T2 and diffusion-weighted imaging (DWI) PI-RADS v2.1 scores. The influence of HB, rectum and bladder distension, breathing motion, and examination hour were analyzed.ResultsThe sharpness and overall image quality of T2 images were significantly better in HB+ compared to HB− (P=0.0047 and P=0.013). T2 motion artifacts were reduced earlier in the day (ρ=0.32, P=0.017). DWI susceptibility artifact correlated with patient diameter (ρ=0.40, P=0.002), but not with rectum diameter (ρ=0.09, P=0.51) or gas content (ρ=0.13, P=0.33). Examinations later in the day were associated with increased motion artifacts on T2 [hazard ratio (HR) =1.36]. T2 and DWI scores were influenced by bladder volume, breathing motion, and rectal air, but not by HB. Breathing motion negatively impacted overall image quality (HR =1.24), and DWI susceptibility artifacts (HR =1.22).ConclusionsHB administration, daytime, and breathing motion have significant influence on image quality of prostate MRI. The gas content of the rectum influences T2 image quality and T2 scores. Bladder filling is associated with reduced breathing motion, subsequently affecting DWI scores.

6060 Background: Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk. Methods: A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. The analysis was performed from the payer perspective with results reported in 2005 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results: Breast MRI provided 23.287 quality-adjusted life-years (QALYs) at a cost of $30,317 while mammography provided 23.141 QALYs at a cost of $7,895 over 25 years of screening. The cost-effectiveness ratios for the two strategies were $1302 and $341, respectively. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $131,376/QALY. In univariate analysis, breast MRI screening became &lt;$50,000/QALY when the cost of the MRI was &lt;$405. In the probabilistic sensitivity analysis, MRI screening produced a net benefit of +0.146 QALYs (95% central range: -0.825 QALYs to +1.378 QALYs). However, breast MRI screening was superior in &lt;1%, &lt;$50,000/QALY in 27%, &gt;$50,000/QALY in 32%, and inferior in 41% of 10,000 probabilistic Monte Carlo simulations. Conclusions: Breast MRI provides a net benefit when compared to mammographic screening for high risk women, however, this approach does not appear to be cost-effective at this time. No significant financial relationships to disclose.

Purpose To investigate the utility and accuracy of breast magnetic resonance (MR) imaging as a supplemental screening tool in women at average risk for breast cancer and to investigate the types of cancer detected with MR imaging screening. Materials and Methods This prospective observational study was conducted at two academic breast centers in women aged 40-70 years without breast cancer-associated risk factors (lifetime risk <15%). Between January 2005 and December 2013, women with at least minimal residual breast tissue (American College of Radiology categories A-D) and normal conventional imaging findings (screening mammography with or without screening ultrasonography [US]) were invited to undergo supplemental MR imaging screening. Outcome measures were supplemental cancer detection rates, interval cancer rates, and biologic profiles of MR imaging-detected additional cancers, as well as specificity and positive predictive value (PPV) of MR imaging screening. Tissue diagnoses or 2 years of follow-up were used to establish the reference standard. Results A total of 2120 women were recruited and underwent 3861 screening MR imaging studies, covering an observation period of 7007 women-years. Breast MR imaging depicted 60 additional breast cancers (ductal carcinoma in situ, n = 20; invasive carcinoma, n = 40) for an overall supplemental cancer detection rate of 15.5 per 1000 cases (95% confidence interval [CI]: 11.9, 20.0). Forty-eight additional cancers were detected with MR imaging at initial screening (supplemental cancer detection rate, 22.6 per 1000 cases). During the 1741 subsequent screening rounds, 12 of 13 incident cancers were found with MR imaging alone (supplemental cancer detection rate, 6.9 per 1000 cases). One cancer was diagnosed with all three methods (mammography, US, and MR imaging), and none were diagnosed with mammography only or US only. Cancers diagnosed with MR imaging were small (median, 8 mm), node negative in 93.4% of cases, and dedifferentiated (high-grade cancer) in 41.7% of cases at prevalence screening and 46.0% of cases at incidence screening. No interval cancers were observed. MR imaging screening offered high specificity (97.1%; 95% CI: 96.5, 97.6) and high PPV (35.7%; 95% CI: 28.9, 43.1). Conclusion In women at average risk for breast cancer, MR imaging screening improves early diagnosis of prognostically relevant breast cancer. © RSNA, 2017 Online supplemental material is available for this article.

Role of breast magnetic resonance imaging in predicting residual lobular carcinoma in situ after initial excision

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, the ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, mammography, ultrasound, and computed tomography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program. To understand the new requirements of the ACR ultrasound accreditation program, and roles the physicist can play in annual equipment surveys and setting up and supervising the routine QC program. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process.