A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

Objectives: While magnetic resonance imaging (MRI) is considered a helpful diagnostic tool in breast imaging, discussions are ongoing about appropriate protocols and indications. The European Society of Breast Imaging (EUSOBI) launched a survey to evaluate the utilisation of breast MRI in clinical practice. Methods: An online survey reviewed by the EUSOBI board and committees was distributed amongst members. The questions encompassed: training and experience; annual breast MRI and MRI-guided-intervention workload; examination protocols; indications; reporting habits and preferences. Data were summarised and subgroups compared using \u3c72test. Results: Of 647 EUSOBI members, 177 (27.4%) answered the survey. The majority were radiologists (90.5%), half of them based in academic centres (51.9%). Common indications for MRI included cancer staging, treatment monitoring, high-risk screening and problem-solving, and differed significantly between countries (p 640.03). Structured reporting and BI-RADS were mostly used. Breast radiologists with 6410 years of experience preferred inclusion of additional techniques, such as T2/STIR (p=0.03) and DWI (p=0.08) in the scan protocol. MRI-guided interventions were performed by a minority of participants (35.4%). Conclusions: The utilisation of breast MRI in clinical practice is generally in line with international recommendations. There are substantial differences between countries. MRI-guided interventions and functional MRI parameters are not widely available. Key points: \u2022 MRI is commonly used for the detection and characterisation of breast lesions. \u2022 Clinical practice standards are generally in line with current recommendations. \u2022 Standardised criteria and diagnostic categories (mainly BI-RADS) are widely adopted. \u2022 Younger radiologists value additional techniques, such as T2/STIR and DWI. \u2022 MRI-guided breast biopsy is not widely available

Der Radiologe / Kontrastmittelfreie Bildgebung der Prostata : Reif für die Praxis?

Hintergrund Die multiparametrische MRT (mpMRT) ist derzeit die genauste Bildgebungsmodalität für die Detektion und das lokale Staging des Prostatakarzinoms (PCa). Nachteile dieser Modalität sind hohe Kosten, großer Zeitaufwand und die Notwendigkeit einer Kontrastmittelgabe. Ziel der Arbeit In diesem Beitrag soll ein Überblick über den aktuellen Stand verkürzter und kontrastmittelfreier MRT-Bildgebungsmöglichkeiten der Prostata vermittelt werden. Ergebnisse Biparametrische Untersuchungsprotokolle und der Einsatz von 3D-T2w-Sequenzen sind bereits erforschte kontrastmittelfreie und schnellere Methoden, mit denen sich die Untersuchungszeit der Prostata ohne wesentliche Einbußen der diagnostischen Genauigkeit verkürzen lässt.Background Multiparametric MRI (mpMRI) is currently the most accurate imaging modality for detection and local staging of prostate cancer (PCa). Disadvantages of this modality are high costs, time consumption and the need for a contrast medium. Aims The aim of the work was to provide an overview of the current state of fast and contrast-free MRI imaging of the prostate. Results Biparametric examination protocols and the use of three-dimensional T2-weighted sequences are readily available methods that can be used to shorten the examination time without sacrificing diagnostic accuracy.(VLID)509261

Der Radiologe / Kontrastmittelfreie Mamma-MRT : Vorteile und potenzielle Nachteile

Hintergrund Die kontrastmittelverstärkte MRT der Mamma ist das sensitivste Verfahren zum Nachweis von Brustkrebs. Der weiteren Verbreitung der Methode stehen der im Vergleich zur Mammographie komplizierte Untersuchungsablauf sowie die Notwendigkeit einer intravenösen Kontrastmittelgabe gegenüber. Fragestellung Kann die diffusionsgewichtete Bildgebung (DWI) die Kontrastmitteldynamik ersetzen und so eine kontrastmittelfreie MRT der Mamma ermöglichen? Material und Methode Der Beitrag gibt eine narrative Übersicht und metaanalytische Betrachtung publizierter Studien. Ergebnisse Mittels DWI können Läsionen der Mamma detektiert und zwischen bösartigen und gutartigen Veränderungen differenziert werden. Sie bietet eine valide Alternative zur kontrastmittelverstärkten MRT und kann als Zusatzmethode zur kontrastmittelverstärkten MRT unnötige Biopsien vermeiden. Nachteil ist die mangelhafte Robustheit der Methode mit dem Ergebnis einer variablen, der kontrastmittelverstärkten MRT unterlegenen Sensitivität. Schlussfolgerungen Derzeit kann die DWI als integraler Bestandteil von MRT-Protokollen der Mamma empfohlen werden. Eine alleinige Anwendung im Rahmen kontrastmittelfreier Protokolle befindet sich noch in der Erprobungsphase.Background Contrast-enhanced breast magnetic resonance imaging (MRI) is the most sensitive method for detection of breast cancer. The further spread of breast MRI is limited by the complicated examination procedure and the need for intravenously administered contrast media. Objectives Can diffusion-weighted imaging (DWI) replace contrast-enhanced sequences to achieve an unenhanced breast MRI examination? Materials and methods Narrative review and meta-analytic assessment of previously published studies. Results DWI can visualize breast lesions and distinguish benign from malignant findings. It is thus a valid alternative to contrast-enhanced sequences. As an additional technique, the use of DWI can reduce the numbers of unnecessary breast biopsies. The lack of robustness leading to variable sensitivity that is currently lower than that of contrast-enhanced breast MRI is a disadvantage of DWI. Conclusions Presently, DWI can be recommended as an integral part of clinical breast MRI protocols. The application as a stand-alone technique within unenhanced protocols is still under evaluation.(VLID)509262

External validation of a risk stratification score for b3 breast lesions detected at ultrasound core needle biopsy

10.3390/diagnostics10040181Diagnostics10418

HOW to USE the KAISER SCORE AS A CLINICAL DECISION RULE for DIAGNOSIS in MULTIPARAMETRIC BREAST MRI [КАК ИСПОЛЬЗОВАТЬ ШКАЛУ КАЙЗЕРА ДЛЯ ПРИНЯТИЯ ДИАГНОСТИЧЕСКИХ РЕШЕНИЙ ПРИ МУЛЬТИПАРАМЕТРИЧЕСКОЙ МРТ МОЛОЧНОЙ ЖЕЛЕЗЫ]

Purpose. Development of a universal system for evaluating MRI images of the breast. Material and methods. Due to its superior sensitivity, breast MRI (bMRI) has been established as an important additional diagnostic tool in the breast clinic and is used for screening in patients with an elevated risk for breast cancer. Results. Breast MRI, however, is a complex tool, providing multiple images containing several contrasts. Thus, reading bMRI requires a structured approach. A lack of structure will increase the rate of false-positive findings and sacrifice most of the advantages of bMRI as additional work-up will be required. While the BI-RADS (Breast Imaging Reporting And Data System) lexicon is a major step toward standardised and structured reporting, it does not provide a clinical decision rule with which to guide diagnostic decisions. Such a clinical decision rule, however, is provided by the Kaiser score, which combines five independent diagnostic BI-RADS lexicon criteria (margins, SI-time curve type, internal enhancement and presence of oedema) in an intuitive flowchart. Conclusion. The resulting score provides probabilities of malignancy that can be used for evidence-based decision-making in the breast clinic. Notably, considerable benefits have been demonstrated for radiologists with initial and intermediate experience in bMRI. This pictorial essay is a practical guide to the application of the Kaiser score in the interpretation of breast MRI examinations. Teaching Points. 1)bMRI requires standardisation of patient-management, protocols, and reading set-up. 2) Reading bMRI includes the assessment of breast parenchyma, associated findings, and lesions. 3) Diagnostic decisions should be made according to evidence-based clinical decision rules. 4) The evidence-based Kaiser score is applicable independent of bMRI protocol and scanner. 5) The Kaiser score provides high diagnostic accuracy with low inter-observer variability. © 2020 Russian Electronic Journal of Radiology. All rights reserved