title: MR-directed ("Second-Look") ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings.
abstract: OBJECTIVE
  The objective of our study was to assess the clinical utility of MR-directed ("second-look") ultrasound examination to search for breast lesions detected initially on MRI.
  
  
  METHODS
  A retrospective review was performed of the records of 158 consecutive patients (202 lesions) with breast abnormalities initially detected on MRI between July 2003 and May 2006. All lesions were detected as enhancing findings on a dynamic contrast MR study and were subsequently evaluated with ultrasound. Ultrasound was performed using MR images as a guide to lesion location, size, and morphology. Pathology findings were confirmed by subsequent percutaneous biopsy or lesion excision. Imaging follow-up was used for probably benign lesions, which were not biopsied.
  
  
  RESULTS
  Of the 202 MRI-detected lesions, ultrasound correlation was made in 115 (57%) including 33 malignant lesions and 82 benign lesions. The remaining 87 lesions were not sonographically correlated and included 11 malignant lesions and 76 nonmalignant lesions. Mass lesions identified on MRI were more likely to have a sonographic correlate than nonmasslike lesions (65% vs 12%, respectively); malignant mass lesions were more likely to show an ultrasound correlation (85%). The malignant lesions with successful sonographic correlation tended to present with subtle sonographic findings.
  
  
  CONCLUSIONS
  MR-directed ultrasound of MRI-detected lesions was useful for decision making as part of the diagnostic workup. Malignant lesions were likely to have an ultrasound correlate, especially when they presented as masses on MRI. However, the sonographic findings of these lesions were often subtle, and careful scanning technique was needed for successful MRI-ultrasound correlation.
authors.affiliation: Department of Radiology, The University of Chicago, IL 60637, USA. habe@uchicago.edu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schmidt
authors.forename: Rajshri N
authors.initials: RN
authors.lastname: Shah
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimauchi
authors.forename: Kirti
authors.initials: K
authors.lastname: Kulkarni
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Sennett
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Newstead
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA