Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
To reduce the possibility of recurrence, it is important to know the size and extent of hemangiomas before treatment. Physical examination was sufficient for the diagnosis of hemangioma, but it was insufficient to determine the anatomic relationships in the breast. In mammography the dense breast showed no abnormalities except some rounded calcifications, which probably were phleboliths. Breast ultrasound showed diffuse architectural changes with some hypoechoic bands.
Because T2-weighted MRI provides excellent soft tissue contrast in cavernous hemangiomas (1), we undertook breast MRI to evaluate the ability of T2-weighted and dynamic MRI to confirm the diagnosis and extent of hemangioma.
The MR study was performed with a Impact Expert (Siemens) 1.0 T system with a breast coil. Transaxial, fat-saturated T2-weighted turbo-SE (4,200 ms/90 ms, flip angle 180°) images were obtained with a 300 mm field of view, 5 mm section thickness, and 168 × 256 matrix. In addition, T1-weighted FLASH-2D axial (310 ms/5 ms, flip angle 90°) images were obtained with a 250 mm field of view and 4 mm section thickness before and after intravenous administration of gadopentetate dimeglumine in a dynamic fashion. Images were obtained at 2.4 s intervals beginning immediately after the bolus injection and were obtained 6 min after the injection. Postcontrast fat-saturated T1-weighted turbo-SE (900 ms/12 ms, flip angle 180°) images were obtained at 5 min, 28 s with a slice thickness of 6 mm.
The region of interest was obtained from the enhancing part of the lesion to generate a time-intensity curve. The preenhancement image was subtracted from the postenhancement image on a pixel-to-pixel basis. The hemangioma exhibited high signal intensity in lobular fashion with distinct borders and septations on T2-weighted images (Fig. 1). The tumor extended deeply to involve pectoralis muscle. After contrast material injection, the hemangioma showed no enhancement except one 2 cm nodulus lying anteriorly (Fig. 2). From this hyperintense nodulus, the time-intensity curve was evaluated and an early intensive enhancement was followed by a plateau, as in a carcinoma (Fig. 3). In the postcontrast T1-weighted image 11 min, 28 s after bolus injection, the enhancement of the hemangioma was patchy (Fig. 4).
The hemangioma was operated on, but unfortunately only three specimens from near the thoracic wall were stored. In two specimens vascular cavernous channels and in one specimen also thrombosed vascular channels were found.
