Characterizing the Breast Fascial System Using Cryo-Fluorescence Tomography and MRI
Abstract
Purpose
Current anatomical and surgical literature provides only limited descriptions of the ligaments and connective tissue within the breast fascial system. Much of what is known comes from cadaveric dissections, a method that inherently disrupts the native architecture of the breast. As an alternative, we present a characterization of the breast fascial system using cryo-fluorescence tomography (CFT) and further demonstrate the feasibility of doing such analyses with a more clinically accessible modality (MRI).
Methods
Fifteen sagittal, excised clinical breast tissue samples were imaged with CFT (white-light and fluorescence) and MR (T1-weighted). After vessel-enhancement with a Jerman filter, we segmented and skeletonized the ligaments. Twenty various morphological metrics were computed on the skeletons, including length, tortuosity, number of branch/endpoints, and ligament density. Spearman’s Rank correlation was performed with BMI, age, and bra cup size. Directional consistency between the modalities was assessed by comparing the sign of correlation coefficients across shared ligament metrics.
Results
No statistically significant monotonic associations were observed between demographic variables and ligament morphology metrics for either modality, indicating complex, personalized fascial development. However, several metrics demonstrated moderate trends (|ρ| ≥ 0.3). For the CFT imaging, BMI showed the highest number of moderate correlations (eight) with ligament morphology metrics compared to age and bra cup size, suggesting a stronger association with breast architecture metrics. BMI-related correlations demonstrated the highest directional agreement between modalities, with 70.0% of metrics exhibiting concordant trends, followed closely by age (68.42%) and finally bra cup size (44.44%).
Conclusion
Differences between the MRI and CFT reflect the reduced spatial resolution and partial-volume effects present in the MR imaging, underscoring the high sensitivity of ligament morphology demonstrated with CFT. However, trend consistency suggests the potential to characterize the fascial tissues of the entire breast using MRI, which can be used to optimize breast reconstruction techniques.