Advancements in Breast MR Imaging with Gadopiclenol

Breast MR is a critical tool in the early detection, diagnosis and treatment planning of breast cancer. It offers superior sensitivity over traditional screening methods in identifying tumors to help accurately determine the extent of malignancies, guide biopsies and surgical interventions, and evaluate treatment success.¹ Choosing the appropriate gadolinium-based contrast agent (GBCA) in MR imaging is essential to enhancing lesion visibility and improving diagnostic accuracy, while managing the potential risks of gadolinium retention.

Dr Pinker-Domenig discussed using Elucirem ™ (gadopiclenol) injection for breast MR, particularly in challenging cases where conventional imaging, such as mammography and ultrasound, fall short.

Elucirem is a highly stable macrocyclic GBCA that requires only half the gadolinium dose of conventional, nonspecific GBCAs, addressing practitioners’ concerns about gadolinium exposure.^2,3 The administration of a GBCA improves the contrast between lesions and surrounding tissues by accelerating the relaxation of protons through interaction with gadolinium atoms.⁴ Gadopiclenol delivers twice as much interaction as other GBCAs, resulting in the highest relaxivity among nonspecific GBCAs.⁴

Elucirem™ is indicated for use in adults and children aged 2 years and older, for contrast-enhanced magnetic resonance imaging (MRI). The product is used to detect and visualize lesions with abnormal vascularity in the central nervous system (brain, spine and associated tissues) and the body (head and neck, thorax, abdomen, pelvis, and musculoskeletal system).⁸

“In screening and staging breast cancer, we need to see the lesions well and that can be done with less gadolinium, and we can keep the dose and patient exposure as low as possible,” she said.

Enhancing Diagnostic Precision With Gadopiclenol

Dr Pinker-Domenig explains that breast MR is the most sensitive imaging modality for detecting breast cancer, with studies reporting nearly 75% to 100% sensitivity for cancerous tumors.⁵ Unlike conventional screening methods, such as mammography and ultrasound, the sensitivity of breast MR is independent of breast density.

Breast MR is particularly useful in staging lesions and determining if they’re unifocal (a single tumor in one area of the breast), multifocal (multiple tumors within the same quadrant of the breast), or multicentric (multiple tumors in different quadrants of the breast), she said. MR can also effectively screen high-risk patients, as its high sensitivity and specificity help minimize unnecessary biopsies while detecting cancers at early, treatable stages.⁵

“Breast MR is the most accurate imaging modality for staging of lesioning extent, and it can detect noninvasive breast cancers“ she said. “It also provides crucial information about lesion size, allowing for tailored surgical planning and improved patient outcomes.”

Using a GBCA in breast MR imaging is critical to accurately visualizing abnormal breast tissue.⁶

“We want to use high-relaxivity GBCA, ideally at the lowest dose possible, that still gives us a good image quality,” said Dr Pinker-Domenig. “This is where gadopiclenol comes in because it’s a macrocyclic agent with a very high relaxivity. We can lower the dose of gadolinium while achieving the same imaging results.”

Breast MR with a GBCA improves neoadjuvant chemotherapy monitoring in large and small tumors, including triple-negative and HER2-positive cancers, to optimize surgical candidacy and outcomes, she said.

GBCAs support both morphological and kinetic assessments in MR interpretation, which are critical to guiding biopsy decisions and treatment strategies.⁶ Morphological descriptors such as shape, margin, and internal enhancement characteristics help differentiate benign from malignant lesions, while kinetic assessments focus on contrast enhancement patterns, such as wash-in and wash-out curves, to provide additional clues about lesion behavior and further refine diagnostic certainty.⁶

“Gadopiclenol visualizes neovascularity, which is crucial for identifying even the smallest cancers early, and mitigates concerns about gadolinium retention,” she explained.

Clinical Utility of Gadopiclenol in Breast MRI

In the webinar noted above, Dr Pinker-Domenig presented several case studies showcasing the clinical utility of breast MR with gadopiclenol, including the case of a 34-year-old woman with the BRCA2 gene, which indicated her high risk for breast cancer. MR subtraction imaging clearly visualized a small lesion, which prompted clinicians to perform an MR-guided biopsy.

“MR revealed a small, enhancing lesion not visible on other modalities, underscoring its role in high-risk patient management,” she said. “In this case, it clearly solidified what needed to be done next.”

View this Breast MRI Case

Dr Pinker-Domenig stressed the importance of providing an accurate surgical roadmap of the pathology. Contrast-enhanced MRI can help stage a metaplastic carcinoma, a rare, aggressive form of breast cancer that often presents as invasive ductal carcinoma, a common cancer with a high survival rate.⁷ Accurate visualization with gadopiclenol-enhanced MRI can help with disease management and treatment plans.

“In these patients, we really need to know what’s going on to give them the best surgical planning,” she said. “We want the surgical roadmap to be as perfect as possible because it reduces re-excision rates. The surgeon will know if they have to take out more tissue and can include a bigger area in the surgical field.”

As breast imaging evolves, Dr Pinker-Domenig stressed the importance of balancing diagnostic efficacy with patient safety, advocating for judicious use of contrast agents to minimize gadolinium exposure.

References

1. Gombos, E. C., Jagadeesan, J., Richman, D. M., & Kacher, D. F. (2015, November). Magnetic resonance imaging-guided breast interventions: Role in biopsy targeting and lumpectomies. Magnetic resonance imaging clinics of North America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621771/
2. Loevner LA, Kolumban B, Hutóczki G, et al. Efficacy and safety of gadopiclenol for contrast-enhanced MRI of the central nervous system: the PICTURE randomized clinical trial. Invest Radiol. 2023;58(5):307-313. doi:10.1097/RLI.0000000000000944
3. 4Robic C, Port M, Rousseaux O, et al. Physicochemical and pharmacokinetic profiles of gadopiclenol: a new macrocyclic gadolinium chelate with high T1 relaxivity. Invest Radiol. 2019;54(8):475-484. doi:10.1097/RLI.0000000000000563
4. Breast Mri Indications. UCLA Health. (n.d.-b). https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/birads/breast-mri-indications. Accessed July 19, 2024.
5. Gunduru, M. (2023, August 28). Breast magnetic resonance imaging. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK539727/. Accessed July 19, 2024.
6. Çelik, H., Başara Akın, I., Durak, M. G., & Balcı, P. (2023, January 31). Multimodality imaging and histopathology of Metaplastic Breast Cancer. Diagnostic and interventional radiology (Ankara, Turkey). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679585/
7. Elucirem™ (gadopiclenol) injection [Package Insert]. Princeton, NJ. 5/2024 https://www.guerbet.com/media/12ini2kl/elucirem-uspi-5-2024-clean-version.pdf