title: MR imaging and proton spectroscopy of the breast: how to select the images useful to convey the diagnostic message.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  At the Department of Radiology of the Policlinico San Donato (University of Milan), breast MR is routinely performed at 1.5 T as follows: 36-slice axial 2D short-time inversion-recovery (STIR) sequence; 128-partition 3D gradient-echo coronal sequence (1-mm3 siotropic voxel) before and after rapid automatic intravenous injection of 0.1 mmol/kg of Gd-DOTA (one precontrast and four postcontrast phases). Postprocessing includes temporal subtraction (postcontrast minus precontrast), maximum intensity projections (MIPs), percent enhancement-to-time curves for small regions of interest, and axial and/or sagittal multiplanar reconstructions. Single-voxel 1H-MRS is acquired to characterise focal lesions. Applying this protocol, more than 1,200 images are generated for each examination. We select only four MIPs of an early subtracted dynamic phase: one axial similar to craniocaudal x-ray mammographic views, one coronal, and two lateral similar to lateral 90 degrees x-ray mammographic views. For each lesion described in the report, we select five items, including three images, one graph, and one table: STIR image, precontrast and subtracted postcontrast images (morphology), percent enhancement-to-time curves and a table of raw data generating the curves (dynamics). If 1H-MRS has been performed, we add other five items: two postprocessed spectra (metabolism) and three images localising the volume of interest. Only the selected items are printed on films and attached to the report.
  
  
  RESULTS
  The selected items range usually from four (no detected lesion) to 14 (one lesion, studied also with 1H-MRS), to 44 (five lesions, one of them studied also with 1H-MRS). The percentage of items presented with the report if compared with the total number of generated images is equal to 0.33% (4/1,200), 1.17% (14/1,200), and 2.83% (34/1,200), respectively.
  
  
  CONCLUSIONS
  Breast MR imaging and 1H-MRS can be effectively summarised presenting only a minimal fraction of all generated images.
authors.affiliation: Dipartimento di Scienze Medico-Chirurgische, Servizio di Radiologia, IRCCS Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, I-20097, San Donato Milanese, Milano, Italy. afausto@sirm.org
authors.forename: A
authors.initials: A
authors.lastname: Fausto
authors.forename: A
authors.initials: A
authors.lastname: Magaldi
authors.forename: B
authors.initials: B
authors.lastname: Babaei Paskeh
authors.forename: L
authors.initials: L
authors.lastname: Menicagli
authors.forename: E N
authors.initials: EN
authors.lastname: Lupo
authors.forename: F
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016251:CD-ROM; D003287:Contrast Media; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008327:Mammography; D011522:Protons; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media; D011522:Protons