BackgroundMicrocalcification clusters in mammograms can be considered as early signs of breast cancer. However, their detection is a very challenging task because of different factors: large variety of breast composition, highly textured breast anatomy, impalpable size of microcalcifications in some cases, as well as inherent low contrast of mammograms. Thus, the need to support the clinicians’ work with an automatic tool.MethodsIn this work a three-phases approach for clustered microcalcification detection is presented. Specifically, it is made up of a pre-processing step, aimed at highlighting potentially interesting breast structures, followed by a single microcalcification detection step, based on Hough transform, that is able to grasp the innate characteristic shape of the structures of interest. Finally, a cluster identification step to group microcalcifications is carried out by means of a clustering algorithm able to codify expert domain rules.ResultsThe detection performance of the proposed method has been evaluated on 364 mammograms of 182 patients obtaining a true positive ratio of 91.78% with 2.87 false positives per image.ConclusionsExperimental results demonstrated that the proposed method is able to detect microcalcification clusters in digital mammograms showing performance comparable to different methodologies exploited in the state-of-art approaches, with the advantage that it does not require any training phase and a large set of data. The performance of the proposed approach remains high even for more difficult clinical cases of mammograms of young women having high-density breast tissue thus resulting in a reduced contrast between microcalcifications and surrounding dense tissues.

OBJECTIVE:The main goal of oncoplastic breast surgery (OBS) is to optimize cosmetic outcomes and reduce patient morbidity, while still providing an oncologically-safe surgical outcome and extending the target population of conservative surgery. Although the growing number of reported experiences with oncoplastic surgery, few studies account for the long-term outcomes.PATIENTS AND METHODS:Between January 2000 and December 2010, 1024 consecutive oncoplastic surgeries were performed and prospectively included in a database. Demographic data, histological and oncological evaluation and surgical complications were recorded. The role of tumor and patients' characteristics on the development of local recurrence and metastases were assessed by multivariate analysis.RESULTS:Median follow up was 74.2 months. The average age of patients was 56.24. In 869 patients (84.9%) an invasive tumor and in 155 (15.1%) an in situ tumor (11% DCIS and 4% LIN) was found. The average size of the tumor was 24.5 mm. A positive margin presented in 67 (6.5%) patients. Forty patients (50%) underwent re-excision and 39 (49.4%) underwent mastectomy. The overall breast conservation rate was 96.2%. Reported complications were: 17 wound infections (1.7%); 106 hematomas (10.4%); 94 lymphorrheas (9.2%), 48 partial wound dehiscence (4.7%). Local recurrences (LR) were observed in 49 patients (4.7%). The risk of local recurrence was significantly higher in the group of patients with lymphovascular invasion and with high grade (G) (p < 0.05). 52 (5.07%) distant metastases were reported and the related risk was significantly higher in the group of patients with lymphovascular invasion and with negative receptors (p < 0.05).CONCLUSIONS:Oncoplastic surgery provides an acceptable oncological long-term outcome and can be used to treat with conservative surgery also a selected population of patients who would had otherwise undergone mastectomy in the past.

OBJECTIVE:Autologous fat transfer (AFT) is commonly used to treat implant palpability and prevent fibrosis and thinning in mastectomy skin flaps. A major limit to this procedure is volume retention over time, leading to the introduction of fat enrichment with stromal vascular fraction (SVF+AFT). Oncological concerns have been raised over the injection of an increased concentration of progenitors cells (ASCs) in the SVF. The aim of the study is to evaluate the long-term cancer recurrence risk of SVF+AFT cases compared to AFT, in patients undergoing Nipple Sparing Mastectomy (NSM).PATIENTS AND METHODS:A prospective study was designed to compare three groups of patients undergoing NSM followed by SVF+AFT, AFT or none (control group), after a two-stage breast reconstruction. Patients were strictly followed-up for at least 5-years from the second stage reconstructive procedure. Loco-regional and systemic recurrence rate were evaluated over time as the primary outcome. Logistic regression was used to investigate which factors were associated with recurrence events and independent variables of interest were: surgical technique, age above 50 years old, lympho-vascular invasion, oncological stage, adjuvant or neoadjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy.RESULTS:41 women were included in G1 (SVF+AFT), 64 in G2 (AFT), and 64 in G3 (control group). Loco-regional recurrence rate was 2.4% for G1, 4.7% for G2, and 1.6% for G3. Systemic recurrence was 7.3%, 3.1%, and 3.1%, respectively. Among the variables included, there were no significant risk factors influencing a recurrence event, either loco-regional or systemic. In particular, SVF+AFT (G1) did not increase the oncological recurrence.CONCLUSIONS:Our data suggest that both centrifuged and SVF-enhanced fat transfer have a similar safety level in comparison to patients who did not undergo fat grafting in breast reconstruction after NSM.

Many screening programs use mammography as principal diagnostic tool for detecting breast cancer at a very early stage. Despite the efficacy of the mammograms in highlighting breast diseases, the detection of some lesions is still doubtless for radiologists. In particular, the extremely minute and elongated salt-like particles of microcalcifications are sometimes no larger than 0.1 mm and represent approximately half of all cancer detected by means of mammograms. Hence the need for automatic tools able to support radiologists in their work. Here, we propose a computer assisted diagnostic tool to support radiologists in identifying microcalcifications in full (native) digital mammographic images. The proposed CAD system consists of a pre-processing step, that improves contrast and reduces noise by applying Sobel edge detection algorithm and Gaussian filter, followed by a microcalcification detection step performed by exploiting the circular Hough transform. The procedure performance was tested on 200 images coming from the Breast Cancer Digital Repository (BCDR), a publicly available database. The automatically detected clusters of microcalcifications were evaluated by skilled radiologists which asses the validity of the correctly identified regions of interest as well as the system error in case of missed clustered microcalcifications. The system performance was evaluated in terms of Sensitivity and False Positives per images (FPi) rate resulting comparable to the state-of-art approaches. The proposed model was able to accurately predict the microcalcification clusters obtaining performances (sensibility - 91.78% and FPi rate - 3.99) which favorably compare to other state-of-the-art approaches.

Le développement de l’IRM mammaire induit un développement des biopsies sous IRM devant un rehaussement isolé classé Birads 4 ou 5 sans substratum mammographique ou échographique. À la différence des procédures de biopsies réalisées sous stéréotaxie pour un foyer de microcalcifications ou sous-échographie, l’évaluation de la qualité du prélèvement ou la visualisation en temps réel de la qualité de la procédure est plus difficile dans les biopsies sous IRM. Pour apprécier la fiabilité d’une biopsie sous IRM, les indicateurs sont le taux de faux-négatifs et le taux de sous-estimations. Les sous-estimations correspondent aux lésions dites à risque parmi lesquelles dominent les hyperplasies épithéliales atypiques en macrobiopsie qui s’avèrent être des cancers à la chirurgie et les carcinomes canalaires in situ en macrobiopsie qui s’avèrent être des cancers invasifs à la chirurgie. Cet article analyse le taux de sous-estimation dans les hyperplasies épithéliales atypiques et dans les carcinomes canalaires in situ, retrouvés dans la littérature et dans une étude multicentrique française, l’étude Sifem. Il donne, d’autre part, les facteurs de risque de sous-estimation parmi lesquels domine, dans l’étude Sifem, la présence d’une masse (versus non masse). Cet article propose enfin des recommandations sur la prise en charge chirurgicale devant un diagnostic d’hyperplasie épithéliale atypique ou de carcinome canalaire in situ porté sur une macrobiopsie sous IRM.The development of breast MR has led to the development of MR-guided vacuum assisted biopsies for suspicious MR enhancement without any substratum on mammography or ultrasound. Conversely to stereotically guided biopsies mainly performed on microcalcification for which radiography of the samples allows to check the quality of the procedure and conversely to US-guided biopsies which permits to see the needle in real time, the evaluation of the quality of a procedure guided by MR is more difficult. The criteria for investigating the quality of MR procedure are delayed and include the rate of false negative and the rate of underestimation. Underestimations correspond to risk lesions including mainly atypical ductal hyperplasia, upgraded in cancer at surgery and ductal carcinoma in situ upgraded in invasive cancer at surgery. This article gives the rate of underestimation in atypical ductal hyperplasia and in ductal carcinoma in situ, as shown in the literature and in a multi-institutional French study, the Sifem study. Furthermore, this article analyses the risk factors, including epidemiological factors, histologic factors and imaging factors for underestimation. Among these, the Sifem study has identified as a risk factor of underestimation the presence of a mass at MRI. Lastly, this article discusses recommendation about the management of atypical ductal hyperplasia or ductal carcinoma in situ diagnosed by MRI-guided vacuum assisted biopsy.

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.

This literature review assesses the clinical potential of proton (H-1) magnetic resonance spectroscopy (MRS) of breast lesions. We here illustrate the basic principles of spectrum acquisition for volumes of interest, determined on the basis of dynamic magnetic resonance imaging (MRI) and of MRS postprocessing. We discuss the criteria for interpreting the spectrum with particular reference to the metabolic significance of the peak of total choline containing compounds at 3.2 ppm, a marker that is correlated with malignancy. We then summarise the findings obtained in lesion characterisation (with a possible gain in specificity with respect to dynamic MRI), the assessment of the effects of neoadjuvant chemotherapy and the correlation reported at high-field between the tumour tissue concentration of choline-containing compounds and the presence of lymph node metastases. Lastly, we outline the clinical use of this technique as the final phase of a complete breast MR examination after intravenous administration of paramagnetic contrast material for the dynamic study, with reference to its use by radiologists dedicated to breast imaging.

This literature review assesses the clinical potential of proton ( 1 H) magnetic resonance spectroscopy (MRS) of breast lesions. We here illustrate the basic principles of spectrum acquisition for volumes of interest, determined on the basis of dynamic magnetic resonance imaging (MRI) and of MRS postprocessing. We discuss the criteria for interpreting the spectrum with particular reference to the metabolic significance of the peak of total choline containing compounds at 3.2 ppm, a marker that is correlated with malignancy. We then summarise the findings obtained in lesion characterisation (with a possible gain in specificity with respect to dynamic MRI), the assessment of the effects of neoadjuvant chemotherapy and the correlation reported at high-field between the tumour tissue concentration of choline-containing compounds and the presence of lymph node metastases. Lastly, we outline the clinical use of this technique as the final phase of a complete breast MR examination after intravenous administration of paramagnetic contrast material for the dynamic study, with reference to its use by radiologists dedicated to breast imaging.

The purpose of this study was to propose a short way to summarise a breast magnetic resonance (MR) examination including a precontrast and contrast-enhanced dynamic study and proton spectroscopy (1H-MRS) in order to convey the diagnostic message.

This study was undertaken to assess the value of a chemical (spectral) fat-saturation (fat-sat) pulse added to a T1-weighted spin-echo sequence after intravenous administration of paramagnetic contrast agent in detecting enhancing lesions in multiple sclerosis.

Although regional anaesthesia has become safer, there are an increasing number of articles regarding complications of regional blocks. During the last few years, many authors have suggested the use of ultrasound to minimize the appearance of complications. This review was performed, through a Medline research, to evaluate articles concerning ultrasound and locoregional anaesthesia published until April 2005. A total of 39 articles were reviewed. Technical procedures, the use of ultrasound guidance in epidural anesthesia, the application of this technique for peripheral nerve blocks, and its indications in pregnancy and in pediatric patients were considered. In these articles, all of the authors focused on the advantages of ultrasound guidance. With the help of this technique, correct catheter placement as close to the target as possible was obtained; the spread of local anesthetic administered around the nerve and its roots can be visualized, reducing the doses needed; in addition, it is possible to avoid the most common complications, such as intravascular injection, dura mater puncture, hematoma formation, and nerve injury. Ultrasound guidance is useful in facilitating peripheral and neuroaxial blocks and offers direct visualization of the target, adjacent structures, and local anesthetic spread. The advantages also include a decreased rate of complications and faster onset of blocks. Finally, ultrasound measurements can even result in suggestions to modify established block technique.

Mediastinal critical structures such as trachea, bronchus, esophagus, and heart are among the dose-limiting factors for stereotactic body radiation therapy (SBRT) to central lung lesions. The purpose of this study was to characterize the risk of esophagitis for patients treated with SBRT and to develop a statistical dose-response model to assess the equivalent uniform dose, D10%, D5 cc, D1 cc, and Dmax, to the esophagus and the risk of toxicity. Toxicity outcomes of a dose-escalation study of 56 patients who had taken CyberKnife treatment from 45-60 Gy in 3-7 fractions at the Erasmus MC-Daniel den Hoed Cancer Center were utilized to create the dose-response model for esophagus. A total of 5 grade 2 esophageal complications were reported (Common Terminology Criteria for Adverse Events version 3.0); 4 complications were early effects and 1 complication was a late effect. All analyses were performed in terms of 5-fraction equivalent dosing. According to our study, D1 cc at a dose of 32.9 Gy and Dmax dose of 43.4 Gy corresponded to a complication probability of 50% for grade 2 toxicity. In this series of 58 CyberKnife mediastinal lung cases, no grade 3 or higher esophageal toxicity occurred. Our estimates of esophageal toxicity are compared with the data in the literature. Further research needs to be performed to establish more reliable dose limits as longer follow-up and toxicity outcomes are reported in patients treated with SBRT for central lung lesions.

Our aim was to perform computed tomography arthrography (CTA) and magnetic resonance arthrography (MRA) of the shoulder as a one-shot examination and to evaluate its value on the basis of arthroscopy as a gold standard.

Mammography and ultrasound indicated a cancer of the right breast in a 77-year-old woman with a dual-chamber demand pacemaker. The patient was not pacemaker-dependent. She underwent breast 1.5T magnetic resonance imaging (MRI) (dynamic gradient echo sequence with Gd-DOTA 0.1 mmol/kg). Before the patient entered the MR room, the configuration of the device was changed (the response to magnet was switched from asynchronous to off and the rate-responsive algorithm was disabled). No relevant modifications of heart rhythm or rate were observed during the MR examination. No symptom was reported. Immediately after the examination, the pacemaker interrogation showed neither program changes nor alert warnings. MRI detected a bifocal cancer in the right breast which allowed tailored breast-conserving treatment to be initiated. Histopathology confirmed a bifocal invasive ductal carcinoma.

Recent reports showed a high frequency of osteopenia/osteoporosis in HIV-infected subjects. Mechanism on the basis of this alteration is still unclear, as the direct effect of virus or of antiretroviral drugs. One hundred sixty-one consecutive HIV-infected outpatients aged 30-50 years, both naive and HAART-treated for > 1 year, were included. An interview questionnaire was performed to establish prior pathological, toxic, epidemiological histories, medications intake, physical activity and eating habits. Blood and urinary tests were checked to exclude concomitant diseases, as were markers of bone metabolism and vitamin D3-metabolites. Each subject underwent to a lumbar spine and left hipbone mineral density by DEXA, using WHO criteria for diagnosis of osteopenia/osteoporosis. Radiologist was unaware if the subject was receiving HAART or not. For groups' homogeneity Chi-square, Fisher's exact and Student's I tests were used. Logistic regression analysis was used to find predictors of osteopenia/osteoporosis and linear regression model to find differences in bone mass density. The demographic characteristics of the 48 naive subjects and the 113 on HAART were comparable. Eighty subjects (49.7%) showed osteopenia/osteoporosis: 22 (45.8%) naive and 58 (51.3%) on HAART (P = 0.46). Independent predictors of osteopenia/osteoporosis were female gender (OR: 3.02, 95% CI: 1.26-7.25, P = 0.01 vs. male), older age (OR: 1.10, 95% CI: 1.01-1.20, P = 0.03, for each additional year), low body mass index (OR: 0.78, 95% CI: 0.68-0.91, P = 0.001 for each additional unit) and higher HIV-RNA levels at DEXA (OR: 1.97, 95% CI: 1.16-3.34, P= 0.01 for each additional Log 10), whereas the use of HAART (OR: 2.61, 95% CI: 0.66-10.27, P = 0.17 vs. naive) and the alterations of markers of bone metabolism were not significantly related to osteopenia/osteoporosis. Similar findings were obtained using linear regression model analysis. HIV infected subjects have a high frequency of osteopenia/osteoporosis. Traditional risk factors are predictive of osteopenia/osteoporosis also in HIV-subjects; the association with higher HIV RNA levels can suggest a direct role of HIV itself in the occurrence of bone disease. (c) 2005 Elsevier Inc. All rights reserved.

The current use of highly active antiretroviral therapy (HAART) has dramatically improved the survival of HIV-infected patients.1 HIV infection and HAART have been associated with numerous acute and long-term toxicities, particularly metabolic complications such as lipodystrophy, insulin resistance, diabetes, and dyslipidemia.2 Recently, disturbances of bone metabolism, including premature osteopenia, osteoporosis, and osteonecrosis, have been reported in HIV-infected subjects.3-5 The mechanism underlying these alterations remains not completely explained: several hypotheses have been considered, including prolonged use of protease inhibitors (PIs), nucleoside-related mitochondrial toxicity, lactic acidosis, lipodystrophy, immune reconstitution, nutritional and hormonal factors, prior AIDS-related wasting, and HIV infection itself.3,6,7 The direct effect of HIV on osteogenic cells, the activation of proinflammatory cytokines in the tumor necrosis factor family molecule RANKL, and the alterations in the metabolism of vitamin D and its derivatives have been also studied.8,9 The aim of this study was to evaluate the possible role of HAART duration and HIV infection itself and to correlate them with the diagnosis of osteopenia and/or osteoporosis. This study involved HIV-infected subjects aged 30 to 50 years consecutively cared for at our outpatient clinic. Patients with a known history of bone disease, with a long bed rest period (>1 month), with menopause or amenorrhea, with concomitant endocrine diseases (eg, hypogonadism, hyper- or hypothyroidism, hypocortisolism), taking drugs affecting bone metabolism (corticosteroids, levothyroxine, lithium, or estrogens), or with drug or alcohol abuse with evidence of neoplasia, chronic diarrhea, or absorption dysfunction and/or a body mass index (BMI) <20% or >20% of normal ranges were excluded. Data on gender; age; BMI; risk factors for HIV infection; Centers for Disease Control and Prevention (CDC) stage; lipodystrophy (defined by body fat abnormalities consistent with lipoatrophy, lipoaccumulation, or both clinically evident to the patient and the physician); immunovirologic parameters (CD4+ cells and HIV RNA level); hepatitis C virus (HCV) coinfection; and duration of HIV positivity, HAART, and use of individual antiretroviral drugs were recorded. According to the quartiles of HAART duration, 4 groups were identified: G1, <1 year (n = 44); G2, 1 to 3 years (n = 41); G3, 3 to 5 years (n = 41); and G4, >5 years (n = 53). HIV RNA levels were measured by the branched chain DNA (bDNA) technique (Chiron; detection limit of 50 copies/mL), and CD4+ cell counts were measured by elite flow cytometer (Coulter Corporation, Miami, FL). All subjects underwent to dual-energy x-ray absorptiometry (DEXA) scans (QDR 4500 Delphi system; Hologic, Bedford, MA) in the anteroposterior lumbar spine (L1-L4) and left hip sites to evaluate mean bone mineral density (BMD) and total mean t-score and z-score. All DEXA scans were performed at the same radiologic center by a single radiologist. The diagnosis of osteopenia and/or osteoporosis was based on World Health Organization (WHO) criteria.10 Comparisons between categoric groups were performed by the χ2 and Fisher exact tests. The Student t test was used for continuous variables. All P values were 2-tailed. Potential predictors of osteopenia and osteoporosis were evaluated by logistic regression analysis. Variables included were gender, age, risk factors for HIV infection, CDC stage, HCV serostatus, BMI, CD4 cell counts and HIV RNA levels on DEXA, HAART duration, and months of HIV positivity. The SAS software package, version 8.2, for Microsoft Windows was used for the analyses. The study involved 179 HIV-infected consecutive subjects, mostly male (n = 112 [62.6%]) and heterosexual (n = 77 [43.0%]). Twenty-nine (16.2%) were classified as CDC stage C, 60 (33.5%) were HCV coinfected, and 54 (30.2%) had lipodystrophy. The median durations of HIV positivity and HAART were 102 months (interquartile range [IQR]: 52-171 months) and 41 months (IQR: 0-79 months), respectively. Ninety-six subjects (53.6%) had pathologic findings on DEXA, 77 (43.0%) had osteopenia, and 19 (10.6%) had osteoporosis: 17 in G1, 26 in G2, 26 in G3, and 27 in G4. Independent predictors of osteopenia and/or osteoporosis were older age (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.03 to 1.20, P < 0.01 for each additional year), low BMI (OR = 0.82, 95% CI: 0.72 to 0.94, P < 0.01 for each additional unit), high HIV RNA levels (OR = 1.97, 95% CI: 1.26 to 3.08, P < 0.01 for each additional log10 copies/mL), and HAART duration (OR = 4.52, 95% CI: 1.21 to 16.86, P = 0.02 for G2 vs. G1; OR = 4.56, 95% CI: 1.13 to 18.35, P = 0.03 for G3 vs. G1; and OR = 2.90, 95% CI: 0.84 to 10.03, P = 0.09 for G4 vs. G1). Figure 1 shows the cases of osteopenia and/or osteoporosis according to HAART duration (based on the 4 groups considered) and HIV RNA levels.FIGURE 1: Diagnosis of osteopenia and/or osteoporosis according to HAART duration and HIV RNA levels.Osteopenia and osteoporosis are frequent findings in HIV-infected subjects. Their pathogenesis is not completely understood. Similar to lipodystrophy, they were initially attributed to PI-based HAART, but further reports did not confirm this relation. A report of Tebas et al3 demonstrated that subjects receiving PI-containing HAART had a higher risk of osteopenia and/or osteoporosis, but antiretroviral-naive patients were not included in this study. In a more recent study, Bruera et al7 found osteopenia and/or osteoporosis in antiretroviral-naive and HAART patients, and both of these groups had a lower BMD compared with healthy controls. In this report, however, the role and duration of previous antiretroviral regimens were not assessed and the groups were not well balanced for age and BMI. In our study, we included subjects aged 30 to 50 years, excluding all those with clinical conditions possibly related to alterations of bone metabolism to avoid possible confounding factors. We did not include healthy controls because other reports have demonstrated the higher risk of osteopenia and/or osteoporosis in HIV-infected subjects compared with seronegative subjects.3,7 Almost half of our population had osteopenia and/or osteoporosis. Traditional risk factors, such as low BMI and older age, were also confirmed to be predictive in HIV-infected subjects. The correlation between higher HIV RNA levels and osteopenia and/or osteoporosis suggests a direct role of HIV on bone turnover cells. Further, the correlation between HAART duration >1 year and osteopenia and/or osteoporosis suggests a role of antiretroviral treatment, even if we cannot evaluate the role of individual drugs because of the high heterogeneity of regimens used; their role in the occurrence of bone alterations could be better evaluated in a prospective study. To date, the occurrence of osteopenia and/or osteoporosis in HIV-infected subjects is of particular concern. Overall, our data suggest that this condition may be attributable to HAART and HIV infection itself. Marco Bongiovanni, MD* Alfonso Fausto, MD† Paola Cicconi, MD* Laura Menicagli, MD† Sara Melzi, MD* Valentina Emanuela Ligabo, MD* Giampaolo Cornalba, MD‡ Teresa Bini, MD* Francesco Sardanelli, MD† Antonella d'Arminio Monforte, MD* *Institute of Infectious Diseases and Tropical Medicine, L. Sacco Hospital University of Milan Milan, Italy, †Department of Radiology, Policlinico S. Donato, University of Milan, Milan, Italy ‡Department of Diagnostic and Interventional Radiology San Paolo Hospital University of Milan, Milan, Italy

PURPOSE To retrospectively compare three different doses of gadobenate dimeglumine with a standard dose of gadopentetate dimeglumine for magnetic resonance (MR) imaging evaluation of breast vessels and to evaluate the accuracy of one-sided increased vascularity seen on gadobenate dimeglumine-enhanced MR images as an indicator of ipsilateral breast cancer. MATERIALS AND METHODS The original study had local ethics committee approval; informed consent was obtained from all enrolled patients. Ninety-five patients known to have or suspected of having breast cancer were randomly assigned to four groups to receive gadobenate dimeglumine at a dose of 0.05, 0.10, or 0.20 mmol per kilogram of body weight or gadopentetate dimeglumine at a dose of 0.10 mmol/kg. T1-weighted gradient-echo MR images were acquired before and 2 minutes after intravenous contrast material injection. Subtracted images were used to obtain maximum intensity projections (MIPs). Two readers blinded to the type and dose of contrast agent administered scored the MIPs obtained in the dose groups for vessel number, length, and conspicuity from 0, which indicated absent or low breast vascularity, to 3, which indicated high breast vascularity. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of one-sided increased vascularity in association with ipsilateral malignancy for 69 histopathologically confirmed lesions (reference standard) were determined after gadobenate dimeglumine-enhanced MR imaging. RESULTS The mean MIP scores assigned to the gadobenate dimeglumine groups were significantly higher than those assigned to the gadopentetate dimeglumine group (P < or = .044). Histopathologic analysis revealed malignant lesions in 52 of 69 patients examined with gadobenate dimeglumine MR imaging: invasive ductal carcinoma in 45, invasive lobular carcinoma in four, and invasive mixed ductal-lobular carcinoma in three patients. Seventeen patients had benign lesions. Two cases of bilateral invasive cancer with symmetric breast vascular maps were excluded. Thus, the overall sensitivity, specificity, accuracy, PPV, and NPV of one-sided increased vascularity as a finding associated with ipsilateral malignancy were 88% (44 of 50 patients), 82% (14 of 17 patients), 87% (58 of 67 patients), 94% (44 of 47 patients), and 70% (14 of 20 patients), respectively. CONCLUSION Gadobenate dimeglumine is effective for MR imaging evaluation of breast vessels at doses as low as 0.05 mmol/kg. One-sided increased vascularity is an MR imaging finding frequently associated with ipsilateral invasive breast cancer.