title: Axillary lymph node characterization in breast cancer patients using magnetic resonance mammography: a prospective comparative study with FDG PET-CT and healthy women.
abstract: OBJECTIVE
  The aim of this study was to evaluate the capability of dynamic contrast enhanced MR-mammography (MRM) for the interpretation of axillary lymph nodes (LNs) in patients with breast cancer.
  
  
  METHODS
  25 patients with breast cancer preoperatively underwent both FDG positron emission computed tomography (PET-CT) and dynamic contrast enhanced MRM. The maximum signal increase (SImax) and curve shape (types I-III) of contrast enhanced LNs ≥ 0.5 cm (short-axis) were analyzed in MRM and correlated to the maximum standard uptake value (SUVmax) of FDG PET-CT. 29 healthy women with MRM served as control group. Enhancement kinetics of all malignant LNs were compared to LN findings of the healthy control group.
  
  
  RESULTS
  Overall 33 contrast enhanced LNs on preoperative MRM had a corresponding FDG uptake on PET-CT. 30 of the PET positive LNs were classified as surely malignant (mean SUVmax 7.3 (± 5.4)). The mean SImax of these LNs was not significantly different to the control group (222% vs 197%), but malignant LNs had a significantly higher rate of type III curves with rapid washout (93% vs 66%, p = 0.008).
  
  
  CONCLUSIONS
  The maximum signal increase is not capable of differentiating malignant from benign axillary LNs. However, since malignant LNs showed a higher frequency of rapid washout curves (type III curves) on corresponding MRM future studies should concentrate on the analysis of this parameter. In clinical routine the curve shape still should be taken with care as there is a high overlap with benign LNs.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: Julia.Krammer@medma.uni-heidelberg.de.
authors.forename: J
authors.initials: J
authors.lastname: Krammer
authors.forename: K
authors.initials: K
authors.lastname: Wasser
authors.forename: A
authors.initials: A
authors.lastname: Schnitzer
authors.forename: T
authors.initials: T
authors.lastname: Henzler
authors.forename: S O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: C G
authors.initials: CG
authors.lastname: Kaiser
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Breast cancer; Lymph node; MR-mammography; PET-CT