Breast DCE-MRI

Abstract

Rationale and Objectives Breast dynamic contrast enhanced (DCE) MRI scanning protocols vary widely. The purpose of this study was to determine the effects of post-contrast timing on delayed-phase lesion kinetics assessment and ability to discriminate malignant from benign lesions. Materials and Methods Following IRB approval, we retrospectively reviewed all lesions assessed on MR examinations from 4/2005 to 6/2006. DCE-MRI was performed with 90 seconds temporal resolution. Delayed-phase kinetic parameters including percentages of persistent, plateau, and washout, and categorizations of predominant and worst curve type were compared between 4.5 and 7.5 minutes post-contrast. Ability to discriminate benign and malignant lesions based on delayed-phase kinetic parameters was compared between post-contrast timings by receiver operating characteristic (ROC) analysis. Results 280 consecutive breast lesions (206 malignant, 74 benign) were evaluated in 228 women. Comparing kinetics assessments at 7.5 versus 4.5 minutes: volume percentage of washout increased in malignancies by a mean of 9.4% (p<0.0001) and increased slightly in benign lesions (mean 3.2%, p=0.007); predominant curve type categorizations changed significantly only for malignancies (p<0.0001); and worst curve categorizations did not change significantly for either benign or malignant lesions (p>0.05). There were no significant differences between timings in area under ROC curves for delayed-phase kinetic parameters. Conclusion The choice of delayed post-contrast timing more strongly affects the kinetics assessments for malignancies than benign breast lesions, but our results suggest a shortened breast DCE-MRI protocol may not significantly impact diagnostic accuracy. Furthermore, worst curve type classifications are least affected by post-contrast timing and may provide reliable assessment of delayed phase kinetics across protocols.

Abbreviated Magnetic Resonance Imaging for Breast Cancer Screening: Concept, Early Results, and Considerations

“…However, Grimm et al ( 37 ) found that the addition of the second post-contrast series for lesion kinetic analysis did not affect reader sensitivity or specificity. This may be in accordance with previous work which indicated that fewer post-contrast sequences may not significantly impact diagnostic accuracy ( 46 ).…”

Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI

“…Kul et al [29] found that the effectiveness of DWI using ADC mean was lower for NME lesions as compared with masses and that the difference between the ADCs of benign and malignant lesions was smaller for NME lesions. Partridge et al [30] reported that although DWI using a Wtu measurement approach and ADC mean is a promising tool for differential diagnosis for both masses and NME lesions, ADC measurements may be more useful for discriminating benign from malignant in masses than for discriminating lesions with NME enhancement. Recently, studies have investigated intravoxel incoherent motion and quantitative non-gaussian diffusion MRI [31–33].…”

Quantitative analysis of vascular properties derived from ultrafast DCE‐MRI to discriminate malignant and benign breast tumors

“…For example, the size of the vessels that can be resolved is (of course) intimately connected to the spatial resolution and signal-to-noise of the images themselves. Because the breast vasculature was segmented on images with a voxel size of (0.8 mm), 3 vessels with radii much smaller than 0.8 mm cannot be directly segmented. We attempted to overcome this limitation by applying a cost-based search to track possible paths connecting segmented vessels and the lesions, but this estimate cannot be directly validated with our current data set.…”

“…DCE-MRI involves the serial acquisition of heavily T 1weighted images acquired before, during, and after the injection of a paramagnetic contrast agent. 1 Both semi-quantitative and quantitative analysis of DCE-MRI have been shown to provide important insights in both the diagnostic [2][3][4] and prognostic [5][6][7] settings for breast cancer. Within the diagnostic setting, the sensitivity of DCE-MRI has been reported as 88% to 100% 8,9 but with a variable specificity of 63% to 96%.…”