Direct MR galactography is a feasible tool to work up nipple discharge

The feasibility of direct magnetic resonance galactography (dMRG) with intraductal contrast material injection was evaluated. 23 women with pathologic nipple discharge and pathologic conventional galactographic findings underwent physical examination, ultrasonography, and MR imaging before surgery. Besides the standard magnetic resonance mammography protocol additional high 3D-T1 and 3D-T2 MRG sequences were performed before (indirect magnetic resonance galactography, iMRG) and after (dMRG) gadolinium DTPA was injected into the discharging duct. MR findings were analyzed and compared to conventional galactography and histological reports. The 23 patients had a total of 57 findings at conventional galactography. IMRG was pathological in 42% and showed 33% of all pathological findings of conventional galactography. Direct magnetic resonance galactographies (dMRG) were pathological in 87-100%. Depending on the applied dMRG sequence between 67% and 82% of all pathologic findings in conventional galactography could be reproduced. Ductal pathology was significantly better detected with dMRG than with iMRG (P < .01). Eight of 23 women showed additional findings at direct MR galactography in comparison to standard MR mammography. The authors concluded, that dMRG is feasible and may serve as an alternative to conventional galactography in the diagnostic work-up of pathologic nipple discharge. Compared to conventional galactography and standard breast MRI sequences, dMRG may provide additional diagnostic information.

 

Bibliographic Reference::

Schwab SA, Uder M, Schulz-Wendtland R, Bautz WA, Janka R, Wenkel E. "Direct MR galactography: feasibility study.", Radiology. 2008 Oct;249(1):54-61.

 

Siegfried A. Schwab

Department of Radiology, Universität Erlangen-Nürnberg, German