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Constance D. Lehman - One of the best experts on this subject based on the ideXlab platform.
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Clinical and technical considerations for high quality Breast MRI at 3 Tesla.
Journal of magnetic resonance imaging : JMRI, 2013Co-Authors: Habib Rahbar, Savannah C. Partridge, Wendy B. Demartini, Bonnie Thursten, Constance D. LehmanAbstract:The use of Breast MRI at 3 tesla (T) has increased in use substantially in recent years. Potential benefits of moving to higher field strength MRI include improved morphologic and kinetic assessment of Breast lesions through higher spatial and temporal resolution dynamic contrast-enhanced MR examinations. Furthermore, higher field strength holds promise for the development of superior advanced Breast MRI techniques, such as diffusion weighted imaging and MR spectroscopy. To fully realize the benefits of moving to 3T, a thorough understanding of the technical and safety challenges of higher field strength imaging specific to Breast MRI is paramount. Through the use of advanced coil technology, parallel imaging, dual-source parallel radiofrequency excitation, and image-based shimming techniques, many of these limiting technical factors can be overcome to achieve high quality Breast MRI at 3T.
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Breast MRI in community practice equipment and imaging techniques at facilities in the Breast cancer surveillance consortium
Journal of The American College of Radiology, 2010Co-Authors: Wendy B. Demartini, Laura Ichikawa, Karla Kerlikowske, Diana S. M. Buist, Tracy Onega, Bonnie C Yankaskas, Berta M Geller, Robert D Rosenberg, Constance D. LehmanAbstract:Purpose MRI is increasingly used for the detection of Breast carcinoma. Little is known about Breast MRI techniques among community practice facilities. The aim of this study was to evaluate equipment and acquisition techniques used by community facilities across the United States, including compliance with minimum standards by the ACRIN ® 6667 Trial and the European Society of Breast Imaging. Methods Breast Cancer Surveillance Consortium facilities performing Breast MRI were identified and queried by survey regarding Breast MRI equipment and technical parameters. Variables included scanner field strength, coil type, acquisition coverage, slice thickness, and the timing of the initial postcontrast sequence. Results were tallied and percentages of facilities meeting ACRIN ® and European Society of Breast Imaging standards were calculated. Results From 23 facilities performing Breast MRI, results were obtained from 14 (61%) facilities with 16 MRI scanners reporting 18 imaging parameters. Compliance with equipment recommendations of ≥1.5-T field strength was 94% and of a dedicated Breast coil was 100%. Eighty-three percent of acquisitions used bilateral postcontrast techniques, and 78% used slice thickness ≤ 3 mm. The timing of initial postcontrast sequences ranged from 58 seconds to 8 minutes 30 seconds, with 63% meeting recommendations for completion within 4 minutes. Conclusions Nearly all surveyed facilities met ACRIN and European Society of Breast Imaging standards for Breast MRI equipment. The majority met standards for acquisition parameters, although techniques varied, in particular for the timing of initial postcontrast imaging. Further guidelines by the ACR Breast MRI Accreditation Program will be of importance in facilitating standardized and high-quality Breast MRI.
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Indications for Breast MRI in the patient with newly diagnosed Breast cancer.
Journal of the National Comprehensive Cancer Network : JNCCN, 2009Co-Authors: Constance D. Lehman, Wendy B. Demartini, Benjamin O. Anderson, Stephen B. EdgeAbstract:Use of Breast MRI in the preoperative evaluation of patients recently diagnosed with Breast cancer has increased significantly over the past 10 years because of its well-documented high sensitivity for detecting otherwise occult Breast cancer in the affected and contralateral Breasts. However, published research reports on the impact of this improved cancer detection are limited. Equally important are growing concerns that the quality of Breast MRI may vary significantly across practice sites, and therefore the published value of MRI may not be achieved for many patients. This article describes the peer-reviewed, published clinical research trials evaluating Breast MRI in patients with newly diagnosed Breast cancer on which the National Comprehensive Cancer Network (NCCN) practice guidelines are based. The current NCCN guidelines recommend that Breast MRI be considered for patients with a newly diagnosed Breast cancer to evaluate the extent of ipsilateral disease and to screen the contralateral Breast, particularly for women at increased risk for mammographically occult disease. In addition, the guidelines indicate that Breast MRI may be used for patients with axillary nodal adenocarcinoma to identify the primary malignancy. The guidelines stress the importance of having proper equipment, imaging technique, and provider training necessary to achieve high-quality Breast MRI, and emphasize that MRI practice sites should have the ability to perform MRI-guided biopsy or needle localization. In addition to describing the data regarding use of Breast MRI in women with newly diagnosed cancer, this article provides recommendations for the performance of high-quality Breast MRI and suggestions for future research.
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Breast MRI for cancer detection and characterization: a review of evidence-based clinical applications
Academic radiology, 2008Co-Authors: Wendy B. Demartini, Constance D. Lehman, Savannah C. PartridgeAbstract:Rationale and Objectives Breast MRI is an important new tool in the imaging armamentarium for the detection and characterization of Breast carcinoma. Understanding the evidence-supported benefits and potential harms of Breast MRI is important to ensure the appropriate utilization of this medical resource. Materials and Methods This article reviews the clinical settings in which MRI for Breast cancer assessment has been shown to be advantageous. The evidence regarding the diagnostic accuracy of MRI and the impact of this imaging tool on clinical outcomes are described. Novel Breast MRI techniques which may lead to future improvements in performance are discussed. Results Breast MRI has been shown in multiple studies to be advantageous for screening patients at high risk, evaluating patients with a new Breast cancer diagnosis, monitoring treatment response in patients undergoing neoadjuvant chemotherapy and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. Among the limitations of MRI are its high cost and modest specificity resulting in false positive examinations. Conclusions When used in evidence-supported clinical settings, the high sensitivity of MRI results in earlier cancer detection or greater accuracy of detection compared to existing tests for Breast carcinoma. Further scientific endeavors are crucial to optimize the future performance and application of Breast MRI.
Wendy B. Demartini - One of the best experts on this subject based on the ideXlab platform.
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Clinical and technical considerations for high quality Breast MRI at 3 Tesla.
Journal of magnetic resonance imaging : JMRI, 2013Co-Authors: Habib Rahbar, Savannah C. Partridge, Wendy B. Demartini, Bonnie Thursten, Constance D. LehmanAbstract:The use of Breast MRI at 3 tesla (T) has increased in use substantially in recent years. Potential benefits of moving to higher field strength MRI include improved morphologic and kinetic assessment of Breast lesions through higher spatial and temporal resolution dynamic contrast-enhanced MR examinations. Furthermore, higher field strength holds promise for the development of superior advanced Breast MRI techniques, such as diffusion weighted imaging and MR spectroscopy. To fully realize the benefits of moving to 3T, a thorough understanding of the technical and safety challenges of higher field strength imaging specific to Breast MRI is paramount. Through the use of advanced coil technology, parallel imaging, dual-source parallel radiofrequency excitation, and image-based shimming techniques, many of these limiting technical factors can be overcome to achieve high quality Breast MRI at 3T.
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Breast MRI in community practice equipment and imaging techniques at facilities in the Breast cancer surveillance consortium
Journal of The American College of Radiology, 2010Co-Authors: Wendy B. Demartini, Laura Ichikawa, Karla Kerlikowske, Diana S. M. Buist, Tracy Onega, Bonnie C Yankaskas, Berta M Geller, Robert D Rosenberg, Constance D. LehmanAbstract:Purpose MRI is increasingly used for the detection of Breast carcinoma. Little is known about Breast MRI techniques among community practice facilities. The aim of this study was to evaluate equipment and acquisition techniques used by community facilities across the United States, including compliance with minimum standards by the ACRIN ® 6667 Trial and the European Society of Breast Imaging. Methods Breast Cancer Surveillance Consortium facilities performing Breast MRI were identified and queried by survey regarding Breast MRI equipment and technical parameters. Variables included scanner field strength, coil type, acquisition coverage, slice thickness, and the timing of the initial postcontrast sequence. Results were tallied and percentages of facilities meeting ACRIN ® and European Society of Breast Imaging standards were calculated. Results From 23 facilities performing Breast MRI, results were obtained from 14 (61%) facilities with 16 MRI scanners reporting 18 imaging parameters. Compliance with equipment recommendations of ≥1.5-T field strength was 94% and of a dedicated Breast coil was 100%. Eighty-three percent of acquisitions used bilateral postcontrast techniques, and 78% used slice thickness ≤ 3 mm. The timing of initial postcontrast sequences ranged from 58 seconds to 8 minutes 30 seconds, with 63% meeting recommendations for completion within 4 minutes. Conclusions Nearly all surveyed facilities met ACRIN and European Society of Breast Imaging standards for Breast MRI equipment. The majority met standards for acquisition parameters, although techniques varied, in particular for the timing of initial postcontrast imaging. Further guidelines by the ACR Breast MRI Accreditation Program will be of importance in facilitating standardized and high-quality Breast MRI.
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Indications for Breast MRI in the patient with newly diagnosed Breast cancer.
Journal of the National Comprehensive Cancer Network : JNCCN, 2009Co-Authors: Constance D. Lehman, Wendy B. Demartini, Benjamin O. Anderson, Stephen B. EdgeAbstract:Use of Breast MRI in the preoperative evaluation of patients recently diagnosed with Breast cancer has increased significantly over the past 10 years because of its well-documented high sensitivity for detecting otherwise occult Breast cancer in the affected and contralateral Breasts. However, published research reports on the impact of this improved cancer detection are limited. Equally important are growing concerns that the quality of Breast MRI may vary significantly across practice sites, and therefore the published value of MRI may not be achieved for many patients. This article describes the peer-reviewed, published clinical research trials evaluating Breast MRI in patients with newly diagnosed Breast cancer on which the National Comprehensive Cancer Network (NCCN) practice guidelines are based. The current NCCN guidelines recommend that Breast MRI be considered for patients with a newly diagnosed Breast cancer to evaluate the extent of ipsilateral disease and to screen the contralateral Breast, particularly for women at increased risk for mammographically occult disease. In addition, the guidelines indicate that Breast MRI may be used for patients with axillary nodal adenocarcinoma to identify the primary malignancy. The guidelines stress the importance of having proper equipment, imaging technique, and provider training necessary to achieve high-quality Breast MRI, and emphasize that MRI practice sites should have the ability to perform MRI-guided biopsy or needle localization. In addition to describing the data regarding use of Breast MRI in women with newly diagnosed cancer, this article provides recommendations for the performance of high-quality Breast MRI and suggestions for future research.
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Breast MRI for cancer detection and characterization: a review of evidence-based clinical applications
Academic radiology, 2008Co-Authors: Wendy B. Demartini, Constance D. Lehman, Savannah C. PartridgeAbstract:Rationale and Objectives Breast MRI is an important new tool in the imaging armamentarium for the detection and characterization of Breast carcinoma. Understanding the evidence-supported benefits and potential harms of Breast MRI is important to ensure the appropriate utilization of this medical resource. Materials and Methods This article reviews the clinical settings in which MRI for Breast cancer assessment has been shown to be advantageous. The evidence regarding the diagnostic accuracy of MRI and the impact of this imaging tool on clinical outcomes are described. Novel Breast MRI techniques which may lead to future improvements in performance are discussed. Results Breast MRI has been shown in multiple studies to be advantageous for screening patients at high risk, evaluating patients with a new Breast cancer diagnosis, monitoring treatment response in patients undergoing neoadjuvant chemotherapy and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. Among the limitations of MRI are its high cost and modest specificity resulting in false positive examinations. Conclusions When used in evidence-supported clinical settings, the high sensitivity of MRI results in earlier cancer detection or greater accuracy of detection compared to existing tests for Breast carcinoma. Further scientific endeavors are crucial to optimize the future performance and application of Breast MRI.
Stephen B. Edge - One of the best experts on this subject based on the ideXlab platform.
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Indications for Breast MRI in the patient with newly diagnosed Breast cancer.
Journal of the National Comprehensive Cancer Network : JNCCN, 2009Co-Authors: Constance D. Lehman, Wendy B. Demartini, Benjamin O. Anderson, Stephen B. EdgeAbstract:Use of Breast MRI in the preoperative evaluation of patients recently diagnosed with Breast cancer has increased significantly over the past 10 years because of its well-documented high sensitivity for detecting otherwise occult Breast cancer in the affected and contralateral Breasts. However, published research reports on the impact of this improved cancer detection are limited. Equally important are growing concerns that the quality of Breast MRI may vary significantly across practice sites, and therefore the published value of MRI may not be achieved for many patients. This article describes the peer-reviewed, published clinical research trials evaluating Breast MRI in patients with newly diagnosed Breast cancer on which the National Comprehensive Cancer Network (NCCN) practice guidelines are based. The current NCCN guidelines recommend that Breast MRI be considered for patients with a newly diagnosed Breast cancer to evaluate the extent of ipsilateral disease and to screen the contralateral Breast, particularly for women at increased risk for mammographically occult disease. In addition, the guidelines indicate that Breast MRI may be used for patients with axillary nodal adenocarcinoma to identify the primary malignancy. The guidelines stress the importance of having proper equipment, imaging technique, and provider training necessary to achieve high-quality Breast MRI, and emphasize that MRI practice sites should have the ability to perform MRI-guided biopsy or needle localization. In addition to describing the data regarding use of Breast MRI in women with newly diagnosed cancer, this article provides recommendations for the performance of high-quality Breast MRI and suggestions for future research.
Tim H. Emory - One of the best experts on this subject based on the ideXlab platform.
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No Effect of Pretreatment Breast MRI on the Timing of Surgical Treatment of Newly Diagnosed Breast Cancer.
Journal of the American College of Radiology : JACR, 2017Co-Authors: Brian Pogatchnik, Jessica E Kuehn-hajder, Michael T. Nelson, Tim H. EmoryAbstract:Abstract Background Although Breast MRI has been shown to be more sensitive in the diagnosis of Breast cancer than conventional mammography, one criticism Breast MRI has faced in the preoperative treatment planning is that it can delay treatment. Methods A retrospective analysis was performed of all women diagnosed and treated for Breast cancer over three consecutive years at an American university hospital. The subjects were divided into two groups: those who received preoperative Breast MRI and those who did not. There were 189 patients included in this study, of whom 109 (57.67%) received pretreatment Breast MRI. Results Median time to treatment was not significantly different between pretreatment MRI and no pretreatment MRI groups (32 days versus 34.5 days, P = .950). Adjusting for age, detection method, stage, and histology type did not change this conclusion. Conclusions At this institution, preoperative Breast MRI for patients with newly diagnosed Breast cancer seemed to have no significant effect on the timing of surgical treatment in cases of newly diagnosed Breast cancer.
Debra M. Ikeda - One of the best experts on this subject based on the ideXlab platform.
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Updated Breast MRI Lexicon.
European Journal of Radiology, 2012Co-Authors: Debra M. IkedaAbstract:The American College of Radiology (ACR) BI-RADS Breast Imaging Lexicon was developed over a 5 year period, initially organized in 1999 by a Breast MRI “Lesion Diagnosis Working Group” and later by the ACR. This work resulted in a lexicon (dictionary) of terms to describe Breast lesions on contrast-enhanced Breast magnetic resonance imaging studies. The first publication was developed when Breast MRI was first being used and referencing the little data available to produce the lexicon of terms in describing lesions seen on Breast MRI. Even though the ACR Lexicon has proved robust for the most part, since its publication there have been technical advances in Breast MRI hardware, coils and pulse sequences, resulting in new information on Breast cancer morphology and kinetic behavior. Publication on MRI studies using the new hardware and software resulted in increases in cancer sensitivity and specificity in published literature. As a result, information is now available on technical parameters required to obtain both high spatial and temporal resolution on Breast MRI scans that resulted in high sensitivity and specificity. These advances and scientific data were used in developing and updating the new Lexicon. The new Breast MRI Lexicon is chaired by Elizabeth A Morris, M.D and is expected to be published in the fall of 2012. The new ACR Lexicon includes a web-based format (hardcopy is also available), recommends mammography/US/MRI correlation, and has evidence based information with hyperlinks to references. The Lexicon also includes sections on Quality Assessment with technical parameters and kinetic/functional considerations that influence MRI images. There is a new section on audit recommendations. The ACR also lists a separate ACR Breast MRI Accreditation Program that accredits Breast MRI facilities in the United States with technical, outcome and personnel credentialing criteria. Breast MRI Lexicon recommendations include adding T2weighted non-contrast sequences, and combined reporting of MRI with mammographic and ultrasound findings. Finally, simultaneous bilateral MRI scans are recommended and are considered standard of care. There is a new section on Breast implants, with a lexicon describing the implant type, location, and findings commonly seen in intact and ruptured implants. In silicone Breast implant studies, imaging terms include normal radial folds, subcapsular line, linguine and keyhole/teardrop. Importantly, there is a new section describing background parenchymal enhancement (BPE) that describes how much of the normal Breast parenchyma enhances, which in turn can influence the sensitivity of Breast MRI to detect cancer. The BPE can be described as none, minimal, mild, moderate or marked. Terms that previously were used to describe findings seen on Breast MRI such as “diffuse stippled enhancement” may actually represent moderate BPE, which is a normal finding. As before, both morphology and kinetic information is considered important. There are no changes to the kinetic terminology. Morphology terms in the lexicon have been added or deleted, adding terms that were commonly used, and deleting those that were not used in the scientific literature. Deleted terms include central and septal enhancement, and enhancing septations. Morphology additions include clustered ring enhancement in contrast-enhanced studies. Morphology terms that have been revised include “non-masslike” to “non-mass” enhancement, and “irregular” mass margins to “uneven” mass margins in masses that have an irregular shape. Last, the Lexicon recommends a final BIRADS assessment including BIRADS codes 0 – Incomplete, Need Additional Imaging Evaluation, 1 – Negative, 2 – Benign, 3 – Probably Benign, 4 – Suspicious, 5 – Highly Suggestive of Malignancy, and 6 – Known Biopsy Proven Malignancy. The ACR Breast MRI Lexicon publication also includes an atlas that illustrates the key findings described in the lexicon. Because the contributors to the atlas were based both in the USA and around the world, there are a wide variety of techniques and pulse sequences that were used to generate the images. Variability in the examples include axial, sagittal, multi-planar reconstructions, fatsuppressed and non-fat-suppressed images chosen as state-of-theart, providing the reader with the rare chance to view MRI studies of specific findings using high-quality, varying techniques.