1 Department of Radiology and Biomedical Imaging, University of California San Francisco, 1600 Divisadero St, Rm C250, Box 1667, San Francisco, CA 94115.
AJR Am J Roentgenol. 2018 Apr;210(4):927-934. doi: 10.2214/AJR.17.18489. Epub 2018 Feb 28.
The purpose of this study is to determine the frequency of correlation of sonographic and MRI findings after percutaneous sampling of presumed ultrasound correlates to suspicious lesions detected on breast MRI and to describe our initial experiences with limited-sequence MRI for postprocedural clip verification.
Between January 1, 2014, and March 31, 2016, a total of 1947 contrast-enhanced breast MRI examinations were performed, and 245 targeted ultrasound examinations were conducted to identify correlates to suspicious MRI findings. We retrospectively identified all lesions that underwent ultrasound-guided sampling of a presumed sonographic correlate and for which a subsequent postprocedural limited-sequence unenhanced MR image for clip localization was available. This consisted of a T1-weighted non-fat-saturated and a T2-weighted fat-saturated sequence. Frequencies of sonographic-MRI correlation were quantified.
The study cohort consisted of 35 patients with 38 presumed correlates that underwent ultrasound-guided sampling with postprocedural MRI for clip verification. The mean time from percutaneous sampling to postprocedural MRI examination was 1 day. Ten presumed sonographic correlates (26%) were found to localize to a site distinct from the lesion originally identified on MRI. One of these discordant cases revealed malignancy on subsequent MRI-guided biopsy, whereas the presumed sonographic correlate was found to be benign. No patient or lesion characteristics were associated with significantly different frequencies of correlation.
In our initial experiences with MRI performed for postprocedural clip verification, 26% of presumed correlates to suspicious lesions detected on MRI were not the actual correlate, and 10% of these discordant cases ultimately revealed malignancy. Radiologists should take caution presuming that lesions identified on ultrasound actually represent the suspicious lesions detected on MRI. MRI for clip verification may be useful if ultrasound-guided sampling is pursued.
本研究旨在确定经皮穿刺疑似超声相关病变后，超声和 MRI 表现的相关性频率，并描述我们在经皮穿刺活检术后进行有限序列 MRI 以验证夹闭器位置的初步经验。
在 2014 年 1 月 1 日至 2016 年 3 月 31 日期间，共进行了 1947 例增强型乳腺 MRI 检查，同时进行了 245 例靶向超声检查，以确定可疑 MRI 表现的相关病变。我们回顾性地确定了所有接受疑似超声相关病变的超声引导下穿刺活检，并随后进行了经皮穿刺活检术后的有限序列平扫 MRI 检查以定位夹闭器的病变。该检查包括 T1 加权非脂肪饱和和 T2 加权脂肪饱和序列。量化了超声与 MRI 相关性的频率。
本研究队列包括 35 例患者，这些患者的 38 个疑似相关病变均接受了超声引导下的穿刺活检，并进行了术后 MRI 检查以验证夹闭器位置。从经皮穿刺活检到术后 MRI 检查的平均时间为 1 天。10 个疑似超声相关病变（26%）被定位到与最初在 MRI 上识别的病变不同的部位。这些不一致的病例中有 1 例显示恶性病变，而疑似超声相关病变为良性。没有患者或病变特征与相关性频率显著不同相关。
在我们经皮穿刺活检术后进行的 MRI 检查的初步经验中，26%的疑似 MRI 上的可疑病变的超声相关病变实际上并非真正的相关病变，其中 10%的不一致病例最终显示恶性病变。如果进行了超声引导下的穿刺活检，那么放射科医生在假定超声上识别的病变实际上代表 MRI 上的可疑病变时应谨慎。如果进行了经皮穿刺活检，那么进行 MRI 检查以验证夹闭器位置可能会有所帮助。
