title: Direct MR galactography: feasibility study.
abstract: OBJECTIVE
  To compare T1- and T2-weighted direct magnetic resonance (MR) galactography, indirect MR galactography, and conventional galactography in women with pathologic nipple discharge.
  
  
  METHODS
  The study was approved by the institutional review board. Written informed consent was obtained from all patients. Twenty-three women (age range, 30-85 years) with pathologic nipple discharge and pathologic conventional galactographic findings underwent physical examination, ultrasonography, and MR imaging before surgery. A T2-weighted sequence of the affected breast was performed before (indirect MR galactography), and T1- and T2-weighted sequences were performed after (direct MR galactography), gadopentetate dimeglumine was injected into the discharging duct. MR galactographic findings were analyzed and compared with conventional galactographic findings. Sequences used were T2-weighted three-dimensional constructive interference in steady state (CISS), T1-weighted volumetric interpolated breath-hold examination (VIBE), and T1-weighted fast low-angle shot (FLASH).
  
  
  RESULTS
  The 23 patients had a total of 57 findings at conventional galactography. Indirect MR galactography with CISS showed pathologic findings in eight (42%) of 19 patients and showed 15 (33%) of 46 of all findings. Direct MR galactography with CISS showed pathologic findings in 23 (100%) of 23 patients and 47 (82%) of 57 of all findings, that with VIBE showed pathologic findings in 19 (83%) of 23 patients and 38 (67%) of 57 of all findings, and that with FLASH showed pathologic findings in 16 (100%) of 16 patients and 31 (80%) of 39 of all findings. There was a significant (P < .01) difference between indirect MR galactography and all direct MR galactography sequences in the detection of ductal disease. Eight (35%) of 23 women showed additional findings at direct MR galactography in comparison with standard MR imaging sequences.
  
  
  CONCLUSIONS
  MR galactography has the potential to be used in the diagnostic work-up of pathologic nipple discharge. Direct MR galactography shows more disease than does indirect MR galactography. The highest detection rate for ductal disease compared with that at conventional galactography was found with the direct MR galactography CISS and FLASH sequences.
authors.affiliation: Department of Radiology, Universität Erlangen-Nürnberg, Maximiliansplatz 1, D-91054 Erlangen, Germany. siegfriedschwab@gmx.net
authors.forename: Siegfried A
authors.initials: SA
authors.lastname: Schwab
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
authors.forename: Werner A
authors.initials: WA
authors.lastname: Bautz
authors.forename: Rolf
authors.initials: R
authors.lastname: Janka
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wenkel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D042361:Mammary Glands, Human / Q000473:pathology*; D008875:Middle Aged
chemical_list: D019786:Gadolinium DTPA