title: Clinical MR mammography: impact of hormonal status on background enhancement and diagnostic accuracy.
abstract: OBJECTIVE
  Hormonal stimulation can induce background enhancement (BE) in MR mammography (MRM). This fact has been assumed to decrease the accuracy of MRM. Consequently, this report investigates: 1. The prevalence of BE in postmenopausal vs. premenopausal women in correlation to hormonal cycle phase (CP). 2. The impact of hormonal status (HS) and BE on diagnostic accuracy.
  
  
  METHODS
  Consecutive patients over 22 months with complete HS information (week of CP or postmenopausal) were included in this prospective investigation. Exclusion criteria were any hormonal therapy, hysterectomy as well as cancer proven by biopsy. The standard of reference was histopathology. All MRM scans were acquired using the same protocol (1.5 T, dynamic T 1w GRE after 0.1 mmol/kg bw Gd-DTPA i. v.). Two radiologists rated all examinations in consensus according to BI-RADS. BE was defined as: 0 = missing, 1 = moderate, 2 = distinct.
  
  
  RESULTS
  224 patients (150 postmenopausal, 74 premenopausal, 45 in the second week of CP) were included in this study (83 benign and 141 malignant findings). BE was more frequent in premenopausal women (p = 0.006), but did not differ between CP (p = 0.460). Neither HS nor BE had a significant impact on the diagnostic parameters of MRM (p ≥ 0.375). However, regarding BE, the relative number of false positive (FP) findings was highest (5 / 10; 50 %) in the distinct BE group. Regarding HS, 17 % more FP findings were observed in premenopausal women examined outside the second week of CP.
  
  
  CONCLUSIONS
  In premenopausal women, HS leads to increased BE of breast tissue, independent of CP. Distinct BE and less pronounced, non-optimal CP may lead to an increased number of false positive findings.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University, Jena. pascal.baltzer@med.uni-jena.de
authors.forename: P A
authors.initials: PA
authors.lastname: Baltzer
authors.forename: M
authors.initials: M
authors.lastname: Dietzel
authors.forename: T
authors.initials: T
authors.lastname: Vag
authors.forename: H
authors.initials: H
authors.lastname: Burmeister
authors.forename: M
authors.initials: M
authors.lastname: Gajda
authors.forename: O
authors.initials: O
authors.lastname: Camara
authors.forename: S O
authors.initials: SO
authors.lastname: Pfleiderer
authors.forename: W A
authors.initials: WA
authors.lastname: Kaiser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D018275:Carcinoma, Lobular / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D004967:Estrogens / Q000097:blood*; D005260:Female; D018226:Fibroadenoma / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008597:Menstrual Cycle / Q000097:blood*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010212:Papilloma / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D017698:Postmenopause / Q000097:blood*; D011374:Progesterone / Q000097:blood*; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary; D055815:Young Adult
chemical_list: D003287:Contrast Media; D004967:Estrogens; D011374:Progesterone; D019786:Gadolinium DTPA