title: Pathophysiologic basis of contrast enhancement in breast tumors.
abstract: While the diagnostic benefits of gadolinium (Gd)-chelate contrast agents are firmly established in magnetic resonance imaging (MRI) of tumors, the pathophysiologic basis of the enhancement observed and its histopathologic correlate remained vague. Tumor angiogenesis is fundamental for growth and metastasis and also of interest in new therapeutic concepts. By correlative analysis of a) histology; b) vascular density (CD31); and c) vascular permeability (vascular permeability factor/vascular endothelial growth factor [VPF/VEGF]), we found a) significantly (P < 0.001) faster exchange rates in malignant compared with benign breast lesions; b) distinct differences in enhancement characteristics between the histologic types (invasive ductal carcinoma, invasive lobular carcinoma, and ductal carcinoma in situ); and c) dependence of enhancement kinetics on the VPF/VEGF expression. The pathophysiologic basis for the differences in contrast enhancement patterns of tumors detectable by MRI is mainly due to vascular permeability, which leads to more characteristic differences than vascular density. MRI is able to subclassify malignant breast tumors due to their different angiogenetic properties.
authors.affiliation: Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany. m.knopp@dkfz-heidelberg.de
authors.forename: M V
authors.initials: MV
authors.lastname: Knopp
authors.forename: E
authors.initials: E
authors.lastname: Weiss
authors.forename: H P
authors.initials: HP
authors.lastname: Sinn
authors.forename: J
authors.initials: J
authors.lastname: Mattern
authors.forename: H
authors.initials: H
authors.lastname: Junkermann
authors.forename: J
authors.initials: J
authors.lastname: Radeleff
authors.forename: A
authors.initials: A
authors.lastname: Magener
authors.forename: G
authors.initials: G
authors.lastname: Brix
authors.forename: S
authors.initials: S
authors.lastname: Delorme
authors.forename: I
authors.initials: I
authors.lastname: Zuna
authors.forename: G
authors.initials: G
authors.lastname: van Kaick
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000098:blood supply* / Q000378:metabolism; D003287:Contrast Media / Q000493:pharmacokinetics; D016228:Endothelial Growth Factors / Q000378:metabolism; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000503:physiopathology*; D010539:Permeability; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D012372:ROC Curve; D012044:Regression Analysis
chemical_list: D003287:Contrast Media; D016228:Endothelial Growth Factors; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D019786:Gadolinium DTPA