title: Current and future applications of magnetic resonance imaging (MRI) to breast and ovarian cancer patient management.
abstract: Magnetic resonance imaging (MRI) is occupying an increasing niche in the clinical diagnostic workup of several cancers, including breast cancers. Despite the high level of implementation of mammography, it has become apparent that MRI can play at least a complementary role in the imaging and diagnosis of primary breast cancers, including ductal carcinoma in situ, the earliest stage of breast cancer that is associated with an increased risk of invasive breast cancer. This can also be said of inflammatory breast cancer, of low incidence but with high impact on overall breast cancer mortality rates, and for which mammography is not ideal due to the typically diffused nature of this disease. Much of the value of breast MRI is dependent on its high sensitivity, resulting from the use of contrast agent enhancement in the detection of breast cancer. Interest has also increased in the application of diffusion-weighted MRI for early assessment of treatment response in this disease. Regarding ovarian and other gynecological cancers, MRI has already demonstrated value in the evaluation of patients with ovarian masses, uterine leiomyoma, endometrioma, and cervical cancer. Features on MRI suggestive of malignant ovarian tumors are varied, and span irregular or solid components to a cystic mass, prominent septations, evidence of peritoneal, hematogenous, or lymphatic spread, or local invasion. The majority of ovarian malignancies are diagnosed in advanced, incurable stages, where exploratory laparotomy provides the opportunity for maximal debulking. Although a role for MRI has yet to be established in this initial setting or in staging, some studies have shown that high sensitivity may be achieved with contrast agent-enhanced MRI for detection of recurrent disease, including demonstration of macroscopic intraabdominal dissemination and the hallmark omental "cake". Efforts in recent years have been focused on design of MRI contrast agents (MRI-CAs), which either target biomarkers, or take advantage of the different physiology of cancerous cells. MRI-CAs based on gadolinium complexes, ferrumoxides, or other metallic nanoparticles have been investigated. This review will focus on the recent progress in the application of MRI to the imaging of breast and ovarian cancers, and present a possible role for molecularly-targeted contrast agents in enriching the context for MRI-based diagnosis.
authors.affiliation: Department of Molecular and Cellular Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA. jkloster@mdanderson.org
authors.forename: Jim
authors.initials: J
authors.lastname: Klostergaard
authors.forename: Kenia
authors.initials: K
authors.lastname: Parga
authors.forename: Raphael G
authors.initials: RG
authors.lastname: Raptis
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D005544:Forecasting; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends*; D010051:Ovarian Neoplasms / Q000175:diagnosis*
references.citation: Breast. 2010 Feb;19(1):3-6
references.pmid: 20159456
references.citation: Ann Surg. 2010 Apr;251(4):701-7
references.pmid: 20224378
references.citation: J Obstet Gynaecol Res. 2008 Jun;34(3):364-70
references.pmid: 18686352
references.citation: Radiology. 2010 Feb;254(2):342-54
references.pmid: 20089722
references.citation: J Radiol. 2007 Apr;88(4):579-84
references.pmid: 17464257
references.citation: Adv Drug Deliv Rev. 2010 Mar 8;62(3):329-38
references.pmid: 19900496
references.citation: Eur J Radiol. 2011 Mar;77(3):462-7
references.pmid: 19896789
references.citation: AJR Am J Roentgenol. 2008 Sep;191(3):689-99
references.pmid: 18716095
references.citation: Curr Pharm Biotechnol. 2005 Apr;6(2):131-50
references.pmid: 15853692
references.citation: Clin Obstet Gynecol. 2009 Mar;52(1):21-39
references.pmid: 19179859
references.citation: J Natl Cancer Inst. 2007 Sep 19;99(18):1359-61
references.pmid: 17848663
references.citation: Bioconjug Chem. 2007 Sep-Oct;18(5):1474-82
references.pmid: 17711320
references.citation: Radiology. 2010 May;255(2):527-35
references.pmid: 20413763
references.citation: Am J Clin Pathol. 2005 Jun;123 Suppl:S13-57
references.pmid: 16100867
references.citation: Breast. 2010 Feb;19(1):7-9
references.pmid: 20159457
references.citation: Am J Surg. 2008 Sep;196(3):389-97
references.pmid: 18436185
references.citation: BMC Med Imaging. 2009 Apr 07;9:5
references.pmid: 19351404
references.citation: Clin Obstet Gynecol. 2009 Mar;52(1):73-93
references.pmid: 19179862
references.citation: J Am Coll Surg. 2008 Feb;206(2):316-21
references.pmid: 18222386
references.citation: Radiographics. 2002 Nov-Dec;22(6):1305-25
references.pmid: 12432104
references.citation: Cancer Res. 1993 Aug 15;53(16):3830-8
references.pmid: 8339295
references.citation: Am Fam Physician. 2009 Sep 15;80(6):632-4
references.pmid: 19817330
references.citation: Mol Diagn Ther. 2010 Feb 1;14(1):13-22
references.pmid: 20121286
references.citation: J Clin Oncol. 2008 Aug 20;26(24):4012-21
references.pmid: 18711192
references.citation: Eur Radiol. 2008 Jan;18(1):18-23
references.pmid: 17701040
references.citation: Semin Oncol. 2008 Feb;35(1):51-63
references.pmid: 18308146
references.citation: J Natl Cancer Inst. 2009 Sep 16;101(18):1233-5
references.pmid: 19738165
references.citation: J Clin Oncol. 2008 Jan 20;26(3):386-91
references.pmid: 18202414
references.citation: J Natl Cancer Inst. 2010 Feb 3;102(3):170-8
references.pmid: 20071685
references.citation: Pediatr Radiol. 2008 May;38(5):529-37
references.pmid: 18357444
references.citation: Minerva Ginecol. 2008 Apr;60(2):143-54
references.pmid: 18487965
references.citation: Jpn J Clin Oncol. 2005 Mar;35(3):149-53
references.pmid: 15741305
references.citation: Cancer. 2008 Nov 1;113(9):2408-14
references.pmid: 18823018
references.citation: Magn Reson Imaging Clin N Am. 2010 May;18(2):259-76, ix
references.pmid: 20494311
references.citation: Invest Radiol. 2005 Jun;40(6):363-7
references.pmid: 15905723
references.citation: Eur Radiol. 2008 Nov;18(11):2370-80
references.pmid: 18523781
references.citation: Microvasc Res. 2009 Dec;78(3):370-8
references.pmid: 19804787
references.citation: J Natl Compr Canc Netw. 2009 Feb;7(2):193-201
references.pmid: 19200417
references.citation: Int J Hyperthermia. 2009;25(6):405-15
references.pmid: 19657852
references.citation: Acad Radiol. 2008 Feb;15(2):209-21
references.pmid: 18206620
references.citation: AJR Am J Roentgenol. 2009 Aug;193(2):461-70
references.pmid: 19620444
references.citation: Breast Cancer Res Treat. 2008 Jun;109(3):417-26
references.pmid: 17653852
references.citation: Am J Surg. 2009 Oct;198(4):475-81
references.pmid: 19800451
references.citation: Evid Rep Technol Assess (Full Rep). 2006 Feb;(130):1-145
references.pmid: 17854238
references.citation: Surg Clin North Am. 2008 Apr;88(2):361-90, vii
references.pmid: 18381118
references.citation: Expert Opin Drug Deliv. 2009 Nov;6(11):1175-94
references.pmid: 19743894
references.citation: AJR Am J Roentgenol. 2010 Feb;194(2):311-21
references.pmid: 20093590
references.citation: Breast Cancer Res Treat. 2009 Jul;116(1):161-9
references.pmid: 18807269
references.citation: J Biol Inorg Chem. 2009 Feb;14(2):253-60
references.pmid: 18975017
references.citation: Med Phys. 2009 Aug;36(8):3786-94
references.pmid: 19746812
references.citation: Am J Surg. 2009 Aug;198(2):262-9
references.pmid: 19375068
references.citation: CA Cancer J Clin. 2009 Sep-Oct;59(5):290-302
references.pmid: 19679690
references.citation: Lancet. 2010 Feb 13;375(9714):563-71
references.pmid: 20159292
references.citation: Clin Radiol. 2009 Apr;64(4):430-8
references.pmid: 19264189
references.citation: Br J Radiol. 2004 Dec;77(924):1036-9
references.pmid: 15569646
references.citation: Cancer. 1999 Dec 1;86(11 Suppl):2517-24
references.pmid: 10630177
references.citation: Ann Surg Oncol. 2010 Sep;17(9):2395-400
references.pmid: 20217259
references.citation: Med Hist. 2009 Oct;53(4):489-512
references.pmid: 19876511
references.citation: Ann Surg Oncol. 2008 Feb;15(2):452-61
references.pmid: 18026801
references.citation: Acta Radiol. 2009 Jul;50(6):583-94
references.pmid: 19449236
references.citation: Radiol Med. 2009 Mar;114(2):267-85
references.pmid: 19194774
references.citation: Ann Oncol. 2001 Mar;12(3):337-41
references.pmid: 11332145
references.citation: Arch Gynecol Obstet. 2006 Aug;274(5):316-8
references.pmid: 16622685
references.citation: Arch Gynecol Obstet. 2010 Aug;282(2):157-62
references.pmid: 19838723
references.citation: Clin Radiol. 2009 Aug;64(8):815-31
references.pmid: 19589421
references.citation: Clin Radiol. 2005 Mar;60(3):340-8
references.pmid: 15710137
references.citation: Mater Res Bull. 2009 Jun;34(6):415-421
references.pmid: 20582234
references.citation: AJR Am J Roentgenol. 2010 Jun;194(6):1658-63
references.pmid: 20489110
references.citation: Radiol Med. 2010 Feb;115(1):70-82
references.pmid: 20017008
references.citation: MRS Bull. 2009 Jun;34(6):441-448
references.pmid: 26166945
references.citation: Tumori. 2008 Mar-Apr;94(2):226-33
references.pmid: 18564611
references.citation: Breast J. 2007 Nov-Dec;13(6):545-50
references.pmid: 17983393
references.citation: AJR Am J Roentgenol. 2008 Jul;191(1):272-7
references.pmid: 18562758
references.citation: Expert Opin Med Diagn. 2009 Nov 1;3(6):597-605
references.pmid: 19966928
references.citation: Am J Surg. 2008 Dec;196(6):844-48; discussion 849-50
references.pmid: 19095098
references.citation: Cancer. 2009 Apr 15;115(8):1621-30
references.pmid: 19224552
references.citation: Rofo. 2010 Feb;182(2):133-9
references.pmid: 19862658
references.citation: Clin Imaging. 2008 Nov-Dec;32(6):438-42
references.pmid: 19006771
references.citation: Magn Reson Imaging Clin N Am. 2010 May;18(2):277-94, ix
references.pmid: 20494312
references.citation: NMR Biomed. 2009 Jan;22(1):28-39
references.pmid: 18654999