From the Department of Diagnostic and Interventional Radiology, University of Aachen (RWTH), Pauwelsstr 30, 52074 Aachen, Germany (S.S., M.K.); and Department of Radiology , University of Bonn, Germany (H.S., C.K.).
Radiology. 2014 Apr;271(1):45-55. doi: 10.1148/radiol.13131198. Epub 2013 Dec 10.
To prospectively investigate the effects of two antihormonal medications, tamoxifen and aromatase inhibitor (AI), on the degree of background enhancement in breast magnetic resonance (MR) imaging.
This institutional review board-approved study was performed in 40 postmenopausal women (mean age, 63 years; range, 49-78 years) with unilateral breast cancer between January 2005 and December 2010. Informed consent was obtained from all participants. All patients underwent breast MR imaging before starting any medication, under tamoxifen, and after switching to an AI. Qualitative and quantitative degrees of benign parenchymal enhancement were investigated before treatment, under tamoxifen, and under AI. Data were analyzed by using the Wilcoxon singed-rank test and Student t test for matched pairs.
Before treatment, the distribution of background enhancement MR-American College of Radiology (ACR) categories 1, 2, 3, and 4 was 20%, 35%, 33%, and 13%, respectively. With tamoxifen, background enhancement was suppressed, with a distribution of 80%, 15%, 5%, and 0% for MR-ACR categories 1, 2, 3, and 4, respectively. With AI, background enhancement recovered in part, with a distribution of 25%, 53%, 23%, and 0% for categories 1, 2, 3, and 4, respectively. In all 40 women, background enhancement rates were highest before treatment (mean, 51.3% ± 33.3 [standard deviation]). By using tamoxifen, background enhancement rates were significantly reduced (mean, 8.4% ± 9.2), and rose again after the switch to an AI (mean, 22.9% ± 19.1 [P < .001]). Prevalence of benign enhancing foci was 65% (26 of 40) at baseline, 12.5% (five of 40) with tamoxifen, and 40% (16 of 40) with AI.
The effects of tamoxifen and AI on benign parenchymal enhancement differ. Whereas tamoxifen leads to a virtually complete suppression of enhancement, the effects of AI are less pronounced. Accordingly, whereas enhancement is unusual and deserves a more careful work-up in a patient in whom tamoxifen is used, this is not necessarily true for women in whom AIs are used. Online supplemental material is available for this article.
前瞻性研究两种抗激素药物他莫昔芬和芳香化酶抑制剂（AI）对乳腺磁共振（MR）成像背景强化程度的影响。
本研究经机构审查委员会批准，纳入 2005 年 1 月至 2010 年 12 月期间的 40 例绝经后单侧乳腺癌女性（平均年龄 63 岁；范围 49-78 岁）。所有参与者均签署了知情同意书。所有患者在开始任何药物治疗前、服用他莫昔芬期间以及转换为 AI 后均接受了乳腺 MR 成像。在治疗前、服用他莫昔芬期间和服用 AI 后，对良性实质增强的程度进行了定性和定量评估。使用 Wilcoxon 符号秩检验和配对学生 t 检验对数据进行分析。
治疗前，背景增强的磁共振成像美国放射学会（ACR）分级 1、2、3 和 4 分别占 20%、35%、33%和 13%。服用他莫昔芬后，背景增强受到抑制，MR-ACR 分级 1、2、3 和 4 的分布分别为 80%、15%、5%和 0%。服用 AI 后，背景增强部分恢复，MR-ACR 分级 1、2、3 和 4 的分布分别为 25%、53%、23%和 0%。在所有 40 例女性中，背景增强率在治疗前最高（平均值 51.3%±33.3%）。使用他莫昔芬后，背景增强率显著降低（平均值 8.4%±9.2%），而在转换为 AI 后再次升高（平均值 22.9%±19.1%，P<.001）。在基线时，良性增强病灶的发生率为 65%（40 例中有 26 例），服用他莫昔芬后为 12.5%（40 例中有 5 例），服用 AI 后为 40%（40 例中有 16 例）。
他莫昔芬和 AI 对良性实质增强的影响不同。他莫昔芬可导致增强几乎完全抑制，而 AI 的作用则不那么明显。因此，在使用他莫昔芬的患者中，增强不常见且需要更仔细的检查，但在使用 AI 的女性中则不一定如此。本文提供了在线补充材料。
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