Breast lesion localization: a freehand, interactive MR imaging-guided technique.
OBJECTIVE
To evaluate interactive magnetic resonance (MR) imaging-guided preoperative needle localization and hookwire placement in the noncompressed breast in patients in the prone position.


METHODS
Nineteen MR imaging-guided breast lesion localization procedures were performed in 17 patients aged 38-70 years (mean age, 48 years) by using an open-platform breast coil in either a 1.5-T, closed-bore imager (n = 14) or a 0.5-T, open-bore imager (n = 5). Rapid imaging (fast spin-echo, water-selective fast spin-echo, or water-specific three-point Dixon gradient-echo) was alternated with freehand manipulation of an MR-compatible needle to achieve accurate needle placement.


RESULTS
Up to three manipulations of the needle were required during an average of 9 minutes to reach the target lesion. MR imaging findings confirmed the final needle position within 9 mm of the target in all cases. The accuracy of 10 localizations was independently corroborated either at mammography or at ultrasonography. Nine lesions were visible on MR images only.


CONCLUSIONS
Interactive MR imaging-guided, freehand needle localization is simple, accurate, and requires no special stereotactic equipment. Lesions throughout the breast, including those in the anterior part of the breast and those near the chest wall, which can be inaccessible with standard grid or compression-plate techniques, can be localized. A variety of needle trajectories in addition to the horizontal path are possible, including circumareolar approaches and tangential needle paths designed to avoid puncture of implants.
Daniel
B L
BL
Department of Radiology, Stanford University, Lucas MRS/I Center, CA 94305-5488, USA.
Birdwell
R L
RL
Ikeda
D M
DM
Jeffrey
S S
SS
Black
J W
JW
Block
W F
WF
Sawyer-Glover
A M
AM
Glover
G H
GH
Herfkens
R J
RJ
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000473:pathology; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000473:pathology; D004396:Coloring Agents; D003287:Contrast Media; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis / Q000473:pathology; D005348:Fibrocystic Breast Disease / Q000175:diagnosis / Q000473:pathology; D005500:Follow-Up Studies; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000295:instrumentation; D008327:Mammography; D008751:Methylene Blue; D008875:Middle Aged; D009339:Needles; D009942:Organometallic Compounds; D011312:Pressure; D016684:Prone Position; D015642:Radiology, Interventional; D013238:Stereotaxic Techniques; D013909:Thorax / Q000473:pathology; D016217:Ultrasonography, Mammary
D004396:Coloring Agents; D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D008751:Methylene Blue