Borderline ovarian malignancy: ultrasound and fast dynamic MR findings.

Ovarian tumors of borderline malignancy are low-grade malignant neoplasms, and have a rather good prognosis. They account for approximately 10-20% of all ovarian tumors. Very few reports available in literature that analyses ultrasound and MR findings in establishing the diagnosis. The purpose of this study is to describe eight cases of ovarian tumors of borderline malignancy with dynamic gadolinium-enhanced MR imaging. Comparison is made with CA 125 serum levels and ultrasound findings. Early enhancing endocystic vegetations, local cystic masses in, and (irregular) thickened walls of large multicystic tumors were important findings in borderline malignant tumors. The accuracy to detect a malignant tumor of borderline malignancy with CA 125, ultrasound and MRI in these eight cases was 50, 63 and 75%, respectively. MRI is a valuable imaging modality to characterize adnexal tumors and might play a role in preoperative evaluation of borderline malignancies.

Fast dynamic contrast enhanced MR imaging of cervical carcinoma.

The first pass phase of contrast material is most important to study vascularization and perfusion of tissue and can be studied using dynamic magnetic resonance (MR) imaging. The purpose of this prospective study was to evaluate the usefulness of pre-contrast vs. post-contrast and fast dynamic MR imaging in the pre-operative staging of cervical carcinomas. To assess the normal onset of enhancement of the uterus and cervix 15 volunteers underwent dynamic MR imaging. Forty-two consecutive patients with invasive cervical cancer underwent pre-operative evaluation using MR imaging. The results of the MR examinations were correlated with clinical (FIGO) staging under anaesthesia (n = 42) and with histopathological findings after operation (n = 26). The staging results of pre-contrast T1-weighted and T2-weighted turbo spin-echo (TSE) MR images, pre-contrast MR images plus post-contrast enhanced (two dimensional fast low angle shot (FLASH 2-D) post contrast), pre-contrast MR images plus post-contrast enhanced plus fast dynamic enhanced (single slice turbo fast low angle shot (turbo FLASH)) MR images compared to histopathology (n = 26) were 77%, 81% and 85% respectively. The improvement was statistically not significant. The result of MR staging compared to clinical staging (n = 42) with pre-contrast MR images was correct in 79% of the cases. Pre-contrast MR images combined with post-contrast MR images did not significantly improve staging accuracy (83%). Pre-contrast plus post-contrast plus fast dynamic MR imaging improved staging to 91%. However, the improvement was only statistically significant for one reader (P = 0.01), whereas the improvement of the second reader was not significant (P = 0.07). The single slice turbo FLASH images showed enhancement of all squamous cell carcinomas (n = 32) with an average onset of 5s (range 4-8s) during the first 45s of bolus injection of gadolinium. The normal cervix showed enhancement with an average of 10s (range 6-14 s). FLASH 2-D post-contrast images showed less intense enhancement of the cervical tumours with respect to the parametria and other surrounding structures. Fast dynamic MR imaging and to a lesser degree post-contrast MR imaging showed a higher level of confidence than pre-contrast MR. Fast dynamic MRI compared with clinical staging (n = 42) was correct in 91% (38/42) and to histopathology in 85% (22/26). Comparison of clinical staging with histopathology was 85% (22/26). In conclusion, fast dynamic MR imaging is superior to post-contrast and pre-contrast MR imaging and is at least as good as clinical staging in the evaluation of cervical carcinoma.

Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent.

PURPOSE: To evaluate the comparative accuracy of magnetic resonance (MR) imaging relative to mammography and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS AND METHODS: Histologic results and preoperative imaging findings (mammography, US, MR imaging) were analyzed regarding tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS: In 10% of cases, the index tumor was not seen at mammography. With US, 15% of the index tumors were not recognized, while MR imaging missed 2% of the index tumors. On mammographic and US images, tumor size was underestimated significantly (P < .005), by 14% and 18%, respectively, while MR imaging showed no significant difference in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, while US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preoperative imaging modalities in assessing the size and number of malignant lesions in the breast.

MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique.

PURPOSE: To assess the utility of gadolinium-enhanced dynamic magnetic resonance (MR) imaging with turbo fast low-angle shot (TurboFLASH) technique in the differentiation of benign from malignant lesions of the breast. MATERIALS AND METHODS: Contrast material-enhanced MR images were obtained at intervals of 2.3 seconds for 2 minutes. After the first four images were obtained, contrast medium was intravenously injected within 10 seconds. Lesions that enhanced within 11.5 seconds after the aorta opacified were regarded as malignant. Lesions that enhanced more than 11.5 seconds after the aorta were regarded as benign. A centrifugal pattern of enhancement was regarded as a sign that a lesion was benign. RESULTS: Eighty-seven lesions were evaluated. Histologic examination showed 65 lesions were malignant and 22 were benign. Gadolinium-enhanced TurboFLASH imaging had a sensitivity of 95%, a specificity of 86%, and an overall accuracy of 93% in differentiating benign from malignant lesions. CONCLUSION: Gadolinium-enhanced TurboFLASH imaging is a valuable method in the examination of breast lesions suspected of being malignant.