Sardanelli Francesco, Iozzelli Andrea, Fausto Alfonso, Carriero Alessandro, Kirchin Miles A
Department of Radiology, University Hospital Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy.
Radiology. 2005 Jun;235(3):791-7. doi: 10.1148/radiol.2353040733. Epub 2005 Apr 21.
To retrospectively compare three different doses of gadobenate dimeglumine with a standard dose of gadopentetate dimeglumine for magnetic resonance (MR) imaging evaluation of breast vessels and to evaluate the accuracy of one-sided increased vascularity seen on gadobenate dimeglumine-enhanced MR images as an indicator of ipsilateral breast cancer.
The original study had local ethics committee approval; informed consent was obtained from all enrolled patients. Ninety-five patients known to have or suspected of having breast cancer were randomly assigned to four groups to receive gadobenate dimeglumine at a dose of 0.05, 0.10, or 0.20 mmol per kilogram of body weight or gadopentetate dimeglumine at a dose of 0.10 mmol/kg. T1-weighted gradient-echo MR images were acquired before and 2 minutes after intravenous contrast material injection. Subtracted images were used to obtain maximum intensity projections (MIPs). Two readers blinded to the type and dose of contrast agent administered scored the MIPs obtained in the dose groups for vessel number, length, and conspicuity from 0, which indicated absent or low breast vascularity, to 3, which indicated high breast vascularity. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of one-sided increased vascularity in association with ipsilateral malignancy for 69 histopathologically confirmed lesions (reference standard) were determined after gadobenate dimeglumine-enhanced MR imaging.
The mean MIP scores assigned to the gadobenate dimeglumine groups were significantly higher than those assigned to the gadopentetate dimeglumine group (P < or = .044). Histopathologic analysis revealed malignant lesions in 52 of 69 patients examined with gadobenate dimeglumine MR imaging: invasive ductal carcinoma in 45, invasive lobular carcinoma in four, and invasive mixed ductal-lobular carcinoma in three patients. Seventeen patients had benign lesions. Two cases of bilateral invasive cancer with symmetric breast vascular maps were excluded. Thus, the overall sensitivity, specificity, accuracy, PPV, and NPV of one-sided increased vascularity as a finding associated with ipsilateral malignancy were 88% (44 of 50 patients), 82% (14 of 17 patients), 87% (58 of 67 patients), 94% (44 of 47 patients), and 70% (14 of 20 patients), respectively.
Gadobenate dimeglumine is effective for MR imaging evaluation of breast vessels at doses as low as 0.05 mmol/kg. One-sided increased vascularity is an MR imaging finding frequently associated with ipsilateral invasive breast cancer.
回顾性比较三种不同剂量的钆贝葡胺与标准剂量的钆喷酸葡胺用于乳腺血管的磁共振（MR）成像评估，并评估钆贝葡胺增强MR图像上一侧血管增多作为同侧乳腺癌指标的准确性。
原研究获得当地伦理委员会批准；所有入组患者均签署知情同意书。95例已知患有或疑似患有乳腺癌的患者被随机分为四组，分别接受每千克体重0.05、0.10或0.20 mmol的钆贝葡胺，或每千克体重0.10 mmol的钆喷酸葡胺。在静脉注射对比剂前及注射后2分钟采集T1加权梯度回波MR图像。利用减影图像获得最大强度投影（MIP）。两位对所给予对比剂的类型和剂量不知情的阅片者对各剂量组获得的MIP进行评分，血管数量、长度和清晰度的评分从0（表示乳腺血管缺如或稀少）到3（表示乳腺血管丰富）。在钆贝葡胺增强MR成像后，确定69例经组织病理学证实的病变（参考标准）中一侧血管增多与同侧恶性肿瘤相关的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
钆贝葡胺组的平均MIP评分显著高于钆喷酸葡胺组（P≤0.044）。组织病理学分析显示，在69例接受钆贝葡胺MR成像检查的患者中，52例为恶性病变：45例为浸润性导管癌，4例为浸润性小叶癌，3例为浸润性混合性导管 - 小叶癌。17例患者为良性病变。排除2例双侧浸润性癌且乳腺血管分布对称的病例。因此，一侧血管增多作为与同侧恶性肿瘤相关的表现，其总体敏感性、特异性、准确性、PPV和NPV分别为88%（50例患者中的44例）、82%（17例患者中的14例）、87%（67例患者中的58例）、94%（47例患者中的44例）和70%（20例患者中的14例）。
钆贝葡胺在低至0.05 mmol/kg的剂量下对乳腺血管的MR成像评估有效。一侧血管增多是一种常与同侧浸润性乳腺癌相关的MR成像表现。
