A new method to combine contrast-enhanced magnetic resonance imaging during live ultrasound of the breast using volume navigation technique: A study for evaluating feasibility, accuracy and reproducibility in healthy volunteers

Objectives: To evaluate feasibility, accuracy and reproducibility of combined US-MR of the breast using volume navigation technique. Subjects and methods: Five healthy females underwent bilateral contrast-enhanced MR (CE-MR) of the breast in supine position, after positioning three couples of markers on the breast. After CE-MR data uploading in the ultrasound (US) database, manual co-registration was obtained during live US of the breast by means of an electromagnetic transmitter positioned near the subject under examination and two electromagnetic sensors were mounted on the transducer bracket. Transmitter and sensors were connected to a position-sensing unit embedded in the US equipment allowing to track probe position and orientation within the electromagnetic field. Live US image were co-registered to the previously loaded breast CE-MR volume by coupling markers. For each subject, two independent radiologists recorded the examination time and verified twice image alignment using five fixed checkpoints. Pair t Student test and Wilcoxon test were used for statistical analysis. Results: In all subjects US and CE-MR images were successfully combined. The examination time was 10 ± 2 vs. 9 ± 4 min, respectively (p = 0.642; NS). A total of one hundred measurements of images misalignment were performed: the measurements recorded between the two operators were 0.42 ± 0.32 cm and 0.58 ± 0.41 cm (p = 0.161; NS), and 0.50 ± 0.32 cm and 0.56 ± 0.52 cm (p = 0.928; NS), respectively. Discussion: In our preliminary experience, volume navigation technique appears to be a accurate and reproducible method to combine CE-MR image during unilateral US of the breast.