Translated abstract:
Purpose: 1. To define the value of the superparamagnetic iron oxide contrast agent feruglose (Clariscan) in detection and differentiation of benign and malignant breast tumors with dynamic magnetic resonance tomography (MRT). 2. To compare the new macromolecular contrast agent feruglose (molecular weight, MW = 100 kDa) and the standard small molecular contrast agent gadopentetate (MW = 0,5 kDa) in their abilities to differentiate benign and malignant breast lesions. Materials and methods: 25 women with suspiscious breast lesions, diagnosed by clinical examination, conventional mammography and ultrasound, underwent ferugloseenhanced magnetic resonance mammography (MRM). The MR imaging was performed using an axial T2weighted (TR/TE/FA: 4000/150/90°) 2D TSE sequence and axial T1weighted (TR/TE/FA: 14/1/30°) dynamic 3D spoiled fast field echo (FFE) sequence. Images were qualitatively and quantitatively (average signal intensities, SI, precontrast and postcontrast) analyzed. Delta signal intensities were calculated according to the formula: Δ SI = (SI post SI prä)/ SI prä. By kinetic analysis of dynamic magnetic resonance imaging were estimated microvascular characteristics: transendothelial permeability (KPS) and fractional plasma volume (fPV). These MRIderived parameters (KPS and fPV) were correlated with histopathologic tumor grade (SBRscore) and microvessel density (MVD). In 14 patients, in addition to the feruglosestudy, a standard gadopentetateenhanced MRI was performed using an axial T2weighted (TR/TE/FA: 4000/150/90°) 2D TSE sequence and an axial dynamic T1weighted (TR/TE/FA: 9.1/4.6/30°) 3D FFE sequence. Results: KPS values were zero for all but one lesion and above zero in all carcinomas. A highly positive correlation was observed between MRIderived KPS values and SBRtumor grade (r²=0.64, p≤0.05). All breast lesions showed a substantially higher mean tumor peak enhancement data after administration of gadopentetate as compared to feruglose (p<0.05). Ferugloseenhanced MRIs revealed significantly lower mean values for maximum relative enhancement and time to peak for masthopatic lesions as compared to those for carcinomas (p<0.05). With gadopentetate quantitative enhancement patterns were not significantly different between benign and malignant tumors. The distribution of enhancement patterns with feruglose were substantially different (χ² =9.017, p<0.05), but not with gadopentetate (χ² =2.239, p>0.05). Conclusion: Ferugloseenhanced MRI is capable to characterize and grade breast tumors noninvasively in vivo. Feruglose provides a substantially lower enhancement of breast lesions as compared to gadopentetate, but an improved specificity for lesion characterization.