MR-mammography of high-risk patients

Dynamic MR mammography (MRM) has high sensitivity for the demonstration of carcinomas, 63 carcinomas were examined by this technique and all showed a signal increase of more than 90% 60 seconds after the injection of 0.1 mmol/kg Gd-DTPA and an almost constant signal intensity (carcinoma plateau) for a further 7 minutes. These characteristic changes applied only to active tumour areas and not to necrotic or fibrotic tumour regions. A possible explanation is the altered vascular architecture due to the growth of malignant tumours. In the presence of a suspect mammogram a carcinoma can be excluded with a high degree of certainty in the absence of contrast enhancement. Signal enhancement in 54 histologically proven cases of non-proliferative mastopathy and in 52 cases of proliferative mastopathy could be reliably distinguished from carcinomas (p<0.001). In rare cases of proliferative mastopathy the signal changes were suspicious of a carcinoma. Normal signal increase does not exclude proliferative mastopathy with certainty. Patients with increased contrast uptake should be regarded as 'high-risk' and examined at regular intervals. (orig.)