The Adjacent Vessel Sign on Breast MRI: New Data and a Subgroup Analysis for 1,084 Histologically Verified Cases

Objective The adjacent vessel sign (AVS) is a descriptor for differentiating malignant from benign breast lesions on breast MRI (bMRI). This investigation was designed to verify the previous reports on the diagnostic accuracy of AVS and to assess correlation between AVS, histopathological diagnosis, lesion size and lesion grade. Materials and Methods This study was approved by the local ethical committee. Experienced radiologists evaluated 1,084 lesions. The exclusion criteria were no histological verification after bMRI and breast interventions that were done up to one year before bMRI (surgery, core biopsy, chemo- or radiation therapy). The native and dynamic contrast-enhanced T1-weighted series were acquired using standardized protocols. The AVS was rated positive if a vessel leading to a lesion could be visualized. Prevalence of an AVS was correlated with the lesions' size, grade and histology using Chi-square-tests. Results The AVS was significantly associated with malignancy (p < 0.001; sensitivity: 47%, specificity: 88%, positive-predictive-value [PPV]: 85%). Malignant lesions > 2 cm more often presented with an AVS than did those malignant lesions < 2 cm (p < 0.0001; sensitivity: 65%, PPV: 90%). There was no correlation of the AVS with the tumor grade. The prevalence of an AVS didn't significantly differ between invasive lobular carcinomas versus ductal carcinomas. In situ cancers were less frequently associated with an AVS (p < 0.001). Conclusion The adjacent vessel sign was significantly associated with malignancy. Thus, it can be used to accurately assess breast lesions on bMRI. In this study, the AVS was particularly associated with advanced and invasive carcinomas.

[1]  W. Kaiser,et al.  The hook sign for differential diagnosis of malignant from benign lesions in magnetic resonance mammography: Experience in a study of 1084 histologically verified cases , 2010, Acta radiologica.

[2]  Dimitrios L. Arvanitis,et al.  Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound. , 2009, European journal of radiology.

[3]  Saadallah Ramadan,et al.  Proton MRS of the breast in the clinical setting , 2009, NMR in biomedicine.

[4]  L. Bassett,et al.  Investigation of breast cancer using two‐dimensional MRS , 2009, NMR in biomedicine.

[5]  Hiroshi Honda,et al.  Enhanced mass on contrast‐enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast‐enhanced and diffusion‐weighted MR images , 2008, Journal of magnetic resonance imaging : JMRI.

[6]  W. Kaiser,et al.  [Clinical value of computer-assisted analysis in MR mammography. A comparison between two systems and three observers with different levels of experience]. , 2008, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[7]  Francesco Sardanelli,et al.  Gadobenate Dimeglumine as a Contrast Agent for Dynamic Breast Magnetic Resonance Imaging: Effect of Higher Initial Enhancement Thresholds on Diagnostic Performance , 2008, Investigative radiology.

[8]  Woo Kyung Moon,et al.  Index terms: Breast neoplasms Breast, MR , 2006 .

[9]  Karel G M Moons,et al.  Meta-analysis of MR imaging in the diagnosis of breast lesions. , 2008, Radiology.

[10]  J. Shin,et al.  Breast MRI for Evaluating Patients with Metastatic Axillary Lymph Node and Initially Negative Mammography and Sonography , 2007, Korean journal of radiology.

[11]  C. Kuhl.  Current status of breast MR imaging. Part 2. Clinical applications. , 2007, Radiology.

[12]  Wendy B DeMartini,et al.  Breast MR imaging: computer-aided evaluation program for discriminating benign from malignant lesions. , 2007, Radiology.

[13]  Alexandra Athanasiou,et al.  Breast imaging and reporting data system (BIRADS): magnetic resonance imaging. , 2007, European journal of radiology.

[14]  Eun Sook Ko,et al.  MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ , 2007, Korean journal of radiology.

[15]  W. Kaiser,et al.  The adjacent vessel on dynamic contrast-enhanced breast MRI. , 2006, AJR. American journal of roentgenology.

[16]  L. Liberman,et al.  Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. , 2006, AJR. American journal of roentgenology.

[17]  W. Kaiser,et al.  Potential MRI interpretation model: differentiation of benign from malignant breast masses. , 2005, AJR. American journal of roentgenology.

[18]  B. Daniel,et al.  Pathologic correlates of false positive breast magnetic resonance imaging findings: which lesions warrant biopsy? , 2005, American journal of surgery.

[19]  Joachim Boettcher,et al.  Further Signs in the Evaluation of Magnetic Resonance Mammography: A Retrospective Study , 2005, Investigative radiology.

[20]  J. Park,et al.  Human in-vivo 31P MR Spectroscopy of Benign and Malignant Breast Tumors , 2001, Korean journal of radiology.

[21]  J. Boniver,et al.  Assessment of tumor angiogenesis in invasive breast carcinomas: absence of correlation with prognosis and pathological factors , 2000, Virchows Archiv.

[22]  E Grabbe,et al.  Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. , 1999, Radiology.

[23]  I. Ellis,et al.  Pathological prognostic factors in breast cancer. , 1999, Critical reviews in oncology/hematology.

[24]  U. Fischer,et al.  MR imaging of mammographically detected clustered microcalcifications: is there any value? , 1998, Radiology.

[25]  R. Newcombe.  Two-sided confidence intervals for the single proportion: comparison of seven methods. , 1998, Statistics in medicine.

[26]  A. Schauer,et al.  The variability of fibroadenoma in contrast-enhanced dynamic MR mammography. , 1997, AJR. American journal of roentgenology.

[27]  M D Schnall,et al.  Breast MR imaging: interpretation model. , 1997, Radiology.

[28]  Kaiser Wa.  [MR mammography--a critical stocktaking]. , 1996 .

[29]  W. Kaiser.  [MR mammography--a critical stocktaking]. , 1996, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[30]  O Lucidarme,et al.  Clustered breast microcalcifications: evaluation by dynamic contrast-enhanced subtraction MRI. , 1996, Journal of computer assisted tomography.

[31]  F Pozza,et al.  Tumor angiogenesis: a new significant and independent prognostic indicator in early-stage breast carcinoma. , 1992, Journal of the National Cancer Institute.

[32]  I. Ellis,et al.  Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. , 2002, Histopathology.

[33]  J. Folkman,et al.  Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma. , 1991, The New England journal of medicine.

[34]  M. Greenwood.  An Introduction to Medical Statistics , 1932, Nature.