Gadobenate dimeglumine-enhanced MR imaging breast vascular maps: association between invasive cancer and ipsilateral increased vascularity

Purpose: To retrospectively compare three doses of Gd-BOPTA with a standard dose of Gd-DTPA for MR evaluation of breast vessels and to evaluate the accuracy of one-side increased vascularity as an indicator of ipsilateral breast cancer on Gd-BOPTA-enhanced MR images. Methods and Materials: Ninety-five patients with known or suspected breast cancer were randomized to four groups to receive Gd-BOPTA at doses of .05 (n=24), .1 (n=24), or .2 (n=24) mmol/kg or Gd-DTPA at a dose of .1 mmol/kg (n=23). T1-weighted gradient echo images were acquired before and at 2 minutes after intravenous contrast injection. Subtracted images were used to obtain maximum intensity projections (MIPs). A score between 0 (poor) and 3 (extensive) was assigned to the bilateral MIPs of all groups based on vessel number, length and conspicuity. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of one-side increased vascularity in association with ipsilateral malignancy was determined for 69 histologically-confirmed lesions (reference standard) after Gd-BOPTA. Results: Significantly higher mean scores were assigned to the combined Gd-BOPTA groups than to the Gd-DTPA group (P < .044). In patients studied with Gd-BOPTA, histology revealed malignant lesions in 52 patients (invasive ductal, n=45; invasive lobular, n=4; invasive ductal/lobular, n=3) and benign lesions in 17 patients. Two cases of bilateral invasive cancer with symmetric breast vascular maps were excluded to give overall values for sensitivity, specificity, accuracy, PPV and NPV of 88% (44/50), 82% (14/17), 87% (58/67), 94% (44/47) and 70% (14/20), respectively, for one-side increased vascularity as a finding associated with ipsilateral malignancy. Conclusion: Gd-BOPTA is effective for MR evaluation of breast vessels at doses as low as .05 mmol/kg. One-side increased vascularity is an MR finding frequently associated with ipsilateral invasive breast cancer.