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Supine Breast MRI Using Respiratory Triggering

Posted Jun 30, 2017 Updated Apr 10, 2023
By Natasja N.Y. Janssen MSc , Leon C. ter Beek PhD , Claudette E. Loo MD PhD , Gonneke Winter-Warnars MD , Charlotte A.H. Lange MD , Marjolein van Loveren MD , Tanja Alderliesten PhD , Jan-Jakob Sonke PhD , Jasper Nijkamp PhD
10 min read

Rationale and Objectives

This study aims to evaluate if navigator-echo respiratory-triggered magnetic resonance acquisition can acquire supine high-quality breast magnetic resonance imaging (MRI).

Materials and Methods

Supine respiratory-triggered magnetic resonance imaging (Trig-MRI) was compared to supine non-Trig-MRI to evaluate breathing-induced motion artifacts (group 1), and to conventional prone non-Trig-MRI (group 2, 16-channel breast coil), all at 3T. A 32-channel thorax coil was placed on top of a cover to prevent breast deformation. Ten volunteers were scanned in each group, including one patient. The acquisition time was recorded. Image quality was compared by visual examination and by calculation of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image sharpness (IS).

Results

Scan time increased from 56.5 seconds (non-Trig-MRI) to an average of 306 seconds with supine Trig-MRI (range: 120–540 seconds). In group 1, the median values (interquartile range) of SNR, CNR, and IS improved from 11.5 (6.0), 7.3 (3.1), and 0.23 (0.2) cm on supine non-Trig-MRI to 38.1 (29.1), 32.8 (29.7), and 0.12 (0) cm (all P < 0.01) on supine Trig-MRI . All qualitative image parameters in group 1 improved on supine Trig-MRI (all P < 0.01) . In group 2, SNR and CNR improved from 14.7 (6.8) and 12.6 (5.6) on prone non-Trig-MRI to 36.2 (12.2) and 32.7 (12.1) (both P < 0.01) on supine Trig-MRI. IS was similar: 0.10 (0) cm vs 0.11 (0) cm ( P = 0.88) .

Conclusions

Acquisition of high-quality supine breast MRI is possible when respiratory triggering is applied, in a similar setup as during subsequent treatment. Image quality improved when compared to supine non-triggered breast MRI and prone breast MRI, but at the cost of increased acquisition time.

Introduction

Breast-conserving surgery can be challenging in patients with small or non-palpable tumors, where tumor palpation is hampered . Therefore, accurate tumor localization during surgery is essential for achieving negative resection margins and for avoiding re-excisions and local recurrences. Several technologies have been developed to guide the surgeon, such as wire-guided localization and radioactive seed localization . Both methods have led to a decrease in positive resection margins but provide only surrogate position information about the tumor, not the actual 3-D shape and position information with respect to the tumor border.

Recently, Fichtinger et al. have proposed the use of an electromagnetic navigation system for intraoperative tumor tracking in combination with wire-guided localization . Preoperatively, an electromagnetically tracked localization needle is placed over the wire guide under ultrasound guidance. Subsequently, a tracked ultrasound system is used for delineation of the tumor. During surgery, the tracked tumor is shown in combination with a tracked cautery on the navigation screen. This system was found to be safe and feasible by evaluation on six palpable tumors. However, non-palpable tumors are often occult on ultrasound , challenging tumor visualization and delineation.

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Materials and Methods

Imaging Protocols

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Figure 1, Supine positioning for magnetic resonance image acquisition. (a) The cover prevents breast deformation induced by the weight of the thorax coil that will be placed on top. (b) Volunteer positioning with thorax coil on top of the cover.

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Imaging Subjects

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Qualitative Image Assessment

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Quantitative Image Assessment

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Figure 2, Image sharpness was assessed by placing a profile line (yellow) through fibroglandular and fatty tissue on the supine non-Trig-MRI (a) and the supine Trig-MRI (b) . Next, a cumulative Gaussian distribution was fitted to the intensity profile for the supine non-Trig-MRI (c) and the supine Trig-MRI (d) . Note the different scale on the Y -axis in (c) and (d) . Trig-MRI, triggered magnetic resonance imaging. (Color version of figure is available online.)

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Statistical Analysis

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Results

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Group 1

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TABLE 1

Qualitative Evaluation of the Supine Trig- and Non-Trig-MRI Scans of the 10 Volunteers of Group 1 by Four Different Radiologists

Supine Non-Trig-MRI ( n = 40) Supine Trig-MRI ( n = 40)P Value Overall Image Quality <0.01 Good 0 33 Moderate 16 7 Poor 24 0 Distinction between fibroglandular and fatty tissues <0.01 Good 0 38 Moderate 13 2 Poor 27 0 Evaluation of breast <0.01 Good 0 32 Moderate 8 7 Poor 32 1 Evaluation of axilla <0.01 Good 1 34 Moderate 16 5 Poor 23 1 Breathing-induced motion artifacts <0.01 Absent 1 20 Moderate 18 17 Severe 21 3

MRI, magnetic resonance imaging; Trig-MRI, triggered magnetic resonance imaging.

Data are presented as numbers of evaluations.

Figure 3, Examples of supine non-Trig-MRI (a,c, and e) and supine Trig-MRI (b,d, and f) of three different volunteers. The visibility of normal (a and b) and denser (c and d) fibroglandular tissue improved on the supine Trig-MRI. The visibility of the axillary region improved on the supine Trig-MRI as well (e and f) .

TABLE 2

SNR, CNR, and Image Sharpness of the MRI of the Volunteers in Groups 1 and 2

Median SNR (IQR) Median CNR (IQR) Median Image Sharpness (cm) (IQR) Group 1 Supine non-Trig-MRI 11.5 (6.0) 7.3 (3.1) 0.23(0.2) Supine Trig-MRI 38.1 (29.1) 32.8 (29.7) 0.12(0)P value <0.01 <0.01 <0.01 Group 2 Prone non-Trig-MRI 14.7 (6.8) 12.6 (5.6) 0.10(0) Supine Trig-MRI 36.2 (12.2) 32.7 (12.1) 0.11(0)P value <0.01 <0.01 0.88

SNR, signal-to-noise ratio; CNR, contrast-to-noise ratio; IQR, interquartile range; MRI, magnetic resonance imaging, Trig-MRI, triggered magnetic resonance imaging.

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Group 2

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Patient Example

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Figure 4, Example of a prone non-Trig-MRI (a) and a supine Trig-MRI (b) of a patient with a carcinoma in the right breast (delineated in red). Notice the reduced contrast in signal intensity between the tumor and the surrounding fibroglandular tissue in the supine Trig-MRI; this reduced contrast is probably due to the prolonged acquisition time resulting in less optimal timing of the contrast agent. (c) Use of supine Trig-MRI for visualization of patient-specific tumor location, extent, and shape with respect to the surrounding anatomic structures in 3-D space. The tumor model was created by volume rendering based on tumor delineations. Trig-MRI, triggered magnetic resonance imaging. (Color version of figure is available online.)

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Discussion

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Acknowledgment

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Academic Radiology, Volume 24, Issue 7
Journals General Radiology
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