Application of BI-RADS Descriptors in Contrast-Enhanced Dual-Energy Mammography: Comparison with MRI

Abstract

Background: Contrast-enhanced (CE) magnetic resonance imaging (MRI) BI-RADS descriptors are used in the evaluation of contrast-enhanced dual-energy mammography (CEDEM) images of mass lesions and are assumed to be applicable. Patients and Methods: Patients with suspicious mass lesions on mammography (BI-RADS 4 or 5) were included. CEDEM examinations were performed using a modified prototype unit. CE-MRI was performed using a high temporal and high spatial resolution imaging protocol. 2 blinded breast radiologists evaluated all images using criteria related to contrast enhancement intensity and morphology according to the BI-RADS lexicon (5th edition) in 2 sessions. Histopathology was used as the standard of reference. Results: 11 patients with 5 benign and 6 malignant index lesions were included. Enhancement characteristics were similar in the malignant cases. Enhancement of the benign lesions was moderate on CEDEM and strong on MRI. Discrepancies in the BI-RADS descriptors did not influence the final BI-RADS score. Overall, the BI-RADS assessment was almost identical in all cases. 1 malignant lesion was rated BI-RADS 4 with CEDEM and BI-RADS 5 with MRI, and 1 benign was rated BI-RADS 2 and BI-RADS 1, respectively. Conclusion: MRI BI-RADS descriptors of contrast-enhancing lesions can be applied for the morphologic analysis of mass lesions on CEDEM.

Role of Contrast Enhanced Mammography in Cases Presented with Primary Breast Edema

“…Also in our study, non-mass internal enhancement pattern as a clumped pattern (3 cases were detected all proven to be malignant) and heterogeneous pattern as 9 of (12 cases proven to be malignant) showed high prediction probability of malignancy. Following Kamal et al 20 who concluded that segmental, ductal and regional clumped or heterogeneous enhancement was significantly associated with malignant lesions. If subtle architectural distortion was seen on mammography, the underlying lesion can be demonstrated on CEDM.CEDM could detect 32 enhancing mass with descriptive morphology of its shape, margin and enhancement pattern all masses were proven as malignancy.…”

“…They make use of contrast injection to acquire good-quality images and achieve a proper diagnostic performance, aiming adequate morphological assessment. 20 According to the 5th edition of the ACR BI-RADS Atlas, there is a well-defined and standardized lexicon of morphology descriptors to characterize breast lesions on DCE-MRI; yet, there is no similar lexicon for CEDM. The need for a standardized lexicon of morphology descriptors has become essential to analyze and report enhancing lesions identified on CEDM.…”

“…The need for a standardized lexicon of morphology descriptors has become essential to analyze and report enhancing lesions identified on CEDM. 20 Diekmann et al 2 noted that it remains difficult to differentiate between benign and malignant tumors based on the enhancement pattern, as is usual in MRI. Overall, they noted a lack of experience and an absence of standardized diagnostic criteria/imaging protocols for CEDM.…”

Dual Energy X-ray Methods for the Characterization, Quantification and Imaging of Calcification Minerals and Masses in Breast

“…Knogler et al used BI-RADS descriptors of contrast enhanced magnetic resonance imaging for the assessment of contrast enhanced dual energy mammography mass lesion images. 11 women with suspicious mass lesions on their mammograms (BI-RADS 4 or 5) were included [97]. The contrast enhanced dual energy mammography images were obtained from a modified Siemens Mammomat Inspiration unit (Siemens Healthcare) ( Figure 5c).…”

Advanced Imaging for Precision Medicine in Breast Cancer: From Morphology to Function

“…The added value of DBT to mammography in BI-RADS assessment and follow-up management is investigated by Galati et al [51]. Knogler et al [52] present results on CEDM for breast lesion detection, characterization and comparison to DCE-MRI. The potential of DCE-MRI including quantitative pharmacokinetic modeling for the assessment and prediction of response to neoadjuvant chemotherapy in breast cancer overall (Dietzel et al [53]) and with a special focus on inflammatory breast cancer (van Uden et al [54]) is discussed.…”