Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps

Noam Nissan*, Tanir Allweis, Tehillah Menes, Asia Brodsky, Shani Paluch-Shimon, Ilana Haas, Orit Golan, Yaheli Miller, Hani Barlev, Einat Carmon, Malka Brodsky, Debbie Anaby, Philip Lawson, Osnat Halshtok-Neiman, Anat Shalmon, Michael Gotlieb, Renata Faermann, Eli Konen, Miri Sklair-Levy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Purpose: To investigate the effect of lactation on breast cancer conspicuity on dynamic contrast-enhanced (DCE) MRI in comparison with diffusion tensor imaging (DTI) parametric maps. Materials and methods: Eleven lactating patients with 16 biopsy-confirmed pregnancy-associated breast cancer (PABC) lesions were prospectively evaluated by DCE and DTI on a 1.5-T MRI for pre-treatment evaluation. Additionally, DCE datasets of 16 non-lactating age-matched breast cancer patients were retrospectively reviewed, as control. Contrast-to-noise ratio (CNR) comprising two regions of interests of the normal parenchyma was used to assess the differences in the tumor conspicuity on DCE subtraction images between lactating and non-lactating patients, as well as in comparison against DTI parametric maps of λ1, λ2, λ3, mean diffusivity (MD), fractional anisotropy (FA), and maximal anisotropy index, λ1–λ3. Results: CNR values of breast cancer on DCE MRI among lactating patients were reduced by 62% and 58% (p < 0.001) in comparison with those in non-lactating patients, when taking into account the normal contralateral parenchyma and an area of marked background parenchymal enhancement (BPE), respectively. Among the lactating patients, DTI parameters of λ1, λ2, λ3, MD, and λ1–λ3 were significantly decreased, and FA was significantly increased in PABC, relative to the normal lactating parenchyma ROIs. When compared against DCE in the lactating cohort, the CNR on λ1, λ2, λ3, and MD was significantly superior, providing up to 138% more tumor conspicuity, on average. Conclusion: Breast cancer conspicuity on DCE MRI is markedly reduced during lactation owing to the marked BPE. However, the additional application of DTI can improve the visualization and quantitative characterization of PABC, therefore possibly suggesting an additive value in the diagnostic workup of PABC. Key Points: • Breast cancer conspicuity on DCE MRI has decreased by approximately 60% among lactating patients compared with non-lactating controls. • DTI-derived diffusion coefficients and the anisotropy indices of PABC lesions were significantly different than those of the normal lactating fibroglandular tissue. • Among lactating patients, breast cancer conspicuity on DTI-derived parametric maps provided up to 138% increase in contrast-to-noise ratio compared with DCE imaging.

Original languageAmerican English
Pages (from-to)767-777
Number of pages11
JournalEuropean Radiology
Issue number2
StatePublished - 1 Feb 2020

Bibliographical note

Funding Information:
NN thanks Prof. Hadassa Degani from the Weizmann Institute of Science for long hours of stimulating discussions, as well as for the permission to use the proprietary DTI software.

Funding Information:
This study has received funding from The Israel Cancer Association and the Sheba Medical Center and Weizmann Institute of Science Research collaboration biomedical research grant.

Publisher Copyright:
© 2019, European Society of Radiology.


  • Breast
  • Breastfeeding
  • Diffusion
  • Lactating
  • Magnetic resonance imaging


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