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Clinical Article
Magnetic resonance imaging features and related factors of breast edema in idiopathic granulomatous mastitis
ZHAO Qiufeng  LI Qiong  WANG Song  CHAO Huimei  MENG Tian 

Cite this article as: ZHAO Q F, LI Q, WANG S, et al. Magnetic resonance imaging features and related factors of breast edema in idiopathic granulomatous mastitis[J]. Chin J Magn Reson Imaging, 2023, 14(12): 49-53, 59. DOI:10.12015/issn.1674-8034.2023.12.008.

[Abstract] Objective To evaluate the MRI characteristics of breast edema in idiopathic granulomatous mastitis and the associated clinical and radiological factors.Materials and Methods This retrospective study included 129 patients with idiopathic granulomatous mastitis (IGM) from January 2021 to December 2022 in our hospital. All patients were proved by biopsy or surgical pathology and underwent breast MRI before biopsy. The course of disease, serum prolactin (PRL) and vascular endothelial growth factor (VEGF) were collected. The presence or absence of retroareola involvement, the depth of breast involvement, the number of quadrants and the extent of involvement were analyzed from breast magnetic resonance images. Then the appearance of breast edema on T2WI images and breast edema score (BES) were evaluated. The differences in these clinical and radiological characteristics between with and without breast edema groups, and between no or slight breast edema and moderate to severe edema groups were compared with χ2 test and t test. The logistic regression was used for multivariable analysis of significant variables.Results Among the 129 patients with IGM, 124 cases involved unilateral breast and 5 cases involved bilateral breasts. And totally 139 breasts were analyzed. There were 127 breasts with breast edema (91.4%) and 12 breasts with no breast edema (8.6%). For BES estimation, there were 12 breasts with BES 1 (8.6%), 15 breasts with BES 2 (10.8%), 68 breasts with BES 3 (48.9%) and 44 breasts with BES 4 (31.7%). On multivariate analysis, the significant independent predictors for MRI breast edema features was extension of the lesion [P=0.003, odds ratio (OR)=1.091, 95% confidence interval (CI): 1.035-1.150], the significant independent predictors for the moderate to severe breast edema features were serum PRL, VEGF and extension of the lesion (P<0.05), OR=22.807 (95% CI: 2.281-228.008), 24.140 (95% CI: 2.937-198.409), 1.102 (95% CI: 1.035-1.174), respectively.Conclusions The incidence of breast edema on MRI is high in IGM, and the degree of breast edema is related to the levels of serum PRL and VEGF and the extent of the lesion.
[Keywords] mastitis;idiopathic granulomatous mastitis;breast;breast edema;score;magnetic resonance imaging

ZHAO Qiufeng1   LI Qiong1   WANG Song1*   CHAO Huimei1   MENG Tian2  

1 Department of Radiology, Longhua Hospital of Shanghai University of TCM, Shanghai 200032, China

2 Department of TCM Breast Surgery, Longhua Hospital of Shanghai University of TCM, Shanghai 200032, China

Corresponding author: WANG S, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Budgeted Program of Shanghai University of TCM (No. 2021LK043).
Received  2023-06-21
Accepted  2023-12-01
DOI: 10.12015/issn.1674-8034.2023.12.008
Cite this article as: ZHAO Q F, LI Q, WANG S, et al. Magnetic resonance imaging features and related factors of breast edema in idiopathic granulomatous mastitis[J]. Chin J Magn Reson Imaging, 2023, 14(12): 49-53, 59. DOI:10.12015/issn.1674-8034.2023.12.008.

LEITHNER D, WENGERT G J, HELBICH T H, et al. Clinical role of breast MRI now and going forward[J]. Clin Radiol, 2018, 73(8): 700-714. DOI: 10.1016/j.crad.2017.10.021.
UEMATSU T, KASAMI M. High-spatial-resolution 3-T breast MRI of nonmasslike enhancement lesions: an analysis of their features as significant predictors of malignancy[J]. AJR Am J Roentgenol, 2012, 198(5): 1223-1230. DOI: 10.2214/AJR.11.7350.
UEMATSU T. MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer[J]. Breast Cancer, 2012, 19(4): 289-294. DOI: 10.1007/s12282-012-0346-1.
UEMATSU T, KASAMI M, WATANABE J. Can T2-weighted 3-T breast MRI predict clinically occult inflammatory breast cancer before pathological examination? A single-center experience[J]. Breast Cancer, 2014, 21(1): 115-121. DOI: 10.1007/s12282-012-0425-3.
HARADA T L, UEMATSU T, NAKASHIMA K, et al. Evaluation of breast edema findings at T2-weighted breast MRI is useful for diagnosing occult inflammatory breast cancer and can predict prognosis after neoadjuvant chemotherapy[J]. Radiology, 2021, 299(1): 53-62. DOI: 10.1148/radiol.2021202604.
XU Z Y, DING Y Y, ZHAO K, et al. MRI characteristics of breast edema for assessing axillary lymph node burden in early-stage breast cancer: a retrospective bicentric study[J]. Eur Radiol, 2022, 32(12): 8213-8225. DOI: 10.1007/s00330-022-08896-z.
KWON B R, SHIN S U, KIM S Y, et al. Microcalcifications and peritumoral edema predict survival outcome in luminal breast cancer treated with neoadjuvant chemotherapy[J]. Radiology, 2022, 304(2): 310-319. DOI: 10.1148/radiol.211509.
SANTUCCI D, FAIELLA E, CORDELLI E, et al. The impact of tumor edema on T2-weighted 3T-MRI invasive breast cancer histological characterization: a pilot radiomics study[J/OL]. Cancers, 2021, 13(18): 4635 [2023-06-20]. DOI: 10.3390/cancers13184635.
KAISER W A. Signs in MR-mammography[J/OL]. Signs MR Mammogr, 2008: 1-386 [2023-06-20].
PALA E E, EKMEKCI S, KILIC M, et al. Granulomatous mastitis: a clinical and diagnostic dilemma[J]. Turk Patoloji Derg, 2022, 38(1): 40-45. DOI: 10.5146/tjpath.2021.01554.
ZHAO Q F, XIE T W, FU C X, et al. Differentiation between idiopathic granulomatous mastitis and invasive breast carcinoma, both presenting with non-mass enhancement without rim-enhanced masses: the value of whole-lesion histogram and texture analysis using apparent diffusion coefficient[J/OL]. Eur J Radiol, 2020, 123: 108782 [2023-06-20]. DOI: 10.1016/j.ejrad.2019.108782.
VANOVCANOVA L, LEHOTSKA V, MACHALEKOVA K, et al. Idiopathic Granulomatous Mastitis - a new approach in diagnostics and treatment[J]. Neoplasma, 2019, 66(4): 661-668. DOI: 10.4149/neo_2019_190201N100.
MATICH A, SUD S, BUXI T B S, et al. Idiopathic granulomatous mastitis and its mimics on magnetic resonance imaging: a pictorial review of cases from India[J/OL]. J Clin Imaging Sci, 2020, 10: 53 [2023-06-20]. DOI: 10.25259/JCIS_112_2019.
YILMAZ R, DEMIR A A, KAPLAN A, et al. Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis?[J]. Radiol Med, 2016, 121(11): 857-866. DOI: 10.1007/s11547-016-0666-x.
ALTUNKESER A, ARSLAN F Z, ERYıLMAZ M A. Magnetic resonance imaging findings of idiopathic granulomatous mastitis: can it be an indirect sign of treatment success or fail?[J/OL]. BMC Med Imaging, 2019, 19(1): 94 [2023-06-20]. DOI: 10.1186/s12880-019-0397-2.
ABEL M K, GREENWOOD H, KELIL T, et al. Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma[J/OL]. NPJ Breast Cancer, 2021, 7(1): 25 [2023-06-20]. DOI: 10.1038/s41523-021-00233-9.
YASUMURA K, OGAWA K, ISHIKAWA H, et al. Inflammatory carcinoma of the breast: characteristic findings of MR imaging[J]. Breast Cancer, 1997, 4(3): 161-169. DOI: 10.1007/BF02967070.
RENZ D M, BALTZER P A, BÖTTCHER J, et al. Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study[J]. Eur Radiol, 2008, 18(11): 2370-2380. DOI: 10.1007/s00330-008-1029-3.
YIN Y L, LIU X H, MENG Q J, et al. Idiopathic granulomatous mastitis: etiology, clinical manifestation, diagnosis and treatment[J]. J Invest Surg, 2022, 35(3): 709-720. DOI: 10.1080/08941939.2021.1894516.
BALTZER P A, YANG F, DIETZEL M, et al. Sensitivity and specificity of unilateral edema on T2w-TSE sequences in MR-Mammography considering 974 histologically verified lesions[J]. Breast J, 2010, 16(3): 233-239. DOI: 10.1111/j.1524-4741.2010.00915.x.
ESMAEIL N K, SALIH A M, PSHTIWAN L R A, et al. Management of idiopathic granulomatous mastitis: a single institution experience[J]. Breast Care, 2023, 18(4): 231-238. DOI: 10.1159/000529647.
HUANG Y J, WU H. A retrospective analysis of recurrence risk factors for granulomatous lobular mastitis in 130 patients: more attention should be paied to prolactin level[J]. Ann Palliat Med, 2021, 10(3): 2824-2831. DOI: 10.21037/apm-20-1972.
ZENG Y F, ZHANG D X, FU N, et al. Risk factors for granulomatous mastitis and establishment and validation of a clinical prediction model (nomogram)[J/OL]. Risk Manag Healthc Policy, 2023, 16: 2209-2222 [2023-06-20]. DOI: 10.2147/RMHP.S431228.
KAISER C G, HEROLD M, BALTZER P A, et al. Is "prepectoral edema" a morphologic sign for malignant breast tumors?[J]. Acad Radiol, 2015, 22(6): 684-689. DOI: 10.1016/j.acra.2015.01.009.
LE T H V, KWON S M. Vascular endothelial growth factor biology and its potential as a therapeutic target in rheumatic diseases[J/OL]. Int J Mol Sci, 2021, 22(10): 5387 [2023-06-20]. DOI: 10.3390/ijms22105387.
HEPP M, WERION A, GREEF A D, et al. Oxidative stress-induced Sirtuin1 downregulation correlates to HIF-1α, GLUT-1, and VEGF-A upregulation in Th1 autoimmune hashimoto's thyroiditis[J/OL]. Int J Mol Sci, 2021, 22(8): 3806 [2023-06-20]. DOI: 10.3390/ijms22083806.
AHMAD A, NAWAZ M I. Molecular mechanism of VEGF and its role in pathological angiogenesis[J]. J Cell Biochem, 2022, 123(12): 1938-1965. DOI: 10.1002/jcb.30344.
SMOLANKA I I, BAGMUT I Y, MOVCHAN O V, et al. Features of VEGF and IL-6 expression in patients with inflammatory breast cancer considering molecular-biological characteristics[J]. J Med Life, 2023, 16(1): 153-159. DOI: 10.25122/jml-2022-0172.
BRITZEN-LAURENT N, WEIDINGER C, STÜRZL M. Contribution of blood vessel activation, remodeling and barrier function to inflammatory bowel diseases[J/OL]. Int J Mol Sci, 2023, 24(6): 5517 [2023-06-20]. DOI: 10.3390/ijms24065517.
GUPTA S S, MAYROVITZ H N. The breast edema Enigma: features, diagnosis, treatment, and recommendations[J/OL]. Cureus, 2022, 14(4): e23797 [2023-06-20].

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